OBJECTIVES: To estimate the cost-utility of bariatric surgery relative to ordinary medication therapy for the management of recently diagnosed type 2 diabetes in obese patients in a 40-year time horizon from a Chinese health insurance payer perspective.

METHODS: A decision analytic model using the Markov process was built and analyzed to compare the 40-year time costs and quality-adjusted life-years (QALYs) beweeen bariatric surgery and ordinary medication therapy. Intervention and health care costs for obese patients with type 2 diabetes in bariatric surgery group were calculated based on observed resource utilization in real medical practice from the hospital information system. The corresponding costs in ordinary medication therapy group were derived from Nanjing urban employee basic medical insurance database. The proportion of patients in each group with remission of diabetes at 1 year was observed in the hospital information system. Health-related quality of life was estimated from published literature. Future costs and health outcomes were discounted at 5% annually. A series of sensitivity analyses were performed.

RESULTS: In the base-case analysis, bariatric surgery was both more effective and less costly than the ordinary medication therapy. Over a 40-year time horizon, the mean discounted costs were 79317.80 RMB per surgical therapy patient and 157703.16 RMB per ordinary medication therapy patient. The surgical and ordinary medication therapy patients lived 16.84 and 15.24 discounted QALYs, respectively. Compared to medication therapy, bariatric surgery was associated with a mean health care saving of 78385.36 RMB and 1.6 additional QALYs per patient. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses, and the results were robust.

CONCLUSIONS: Bariatric surgery is a dominant intervention over a 40-year time horizon, which leads to significant cost savings to health insurance payer and increases in health benefits for managing recently diagnosed type 2 diabetes in obese patients in China.