Artikel
Cost-Effectiveness-Analysis of gastric bypass in nonseverely obese patients with insulin-dependent type 2 diabetes mellitus – preliminary results
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Autoren
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Hannes Götz Kenngott
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Julian Täger
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Colette Doerr-Harim
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Markus K. Diener
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Lars Fischer
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Felix Nickel
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Adrian Billeter
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Peter Nawroth
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
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Beat Peter Müller
- Universitätsklinikum Heidelberg, Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
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Background: Diabetes mellitus Type 2 is a growing matter of healthcare as well as a growing matter of expense. In the Diasurg 1 study 20 patients with insulin dependent type 2 diabetes mellitus (T2DM) underwent a laparoscopic Roux-Y-Bypass (LRYGB). This cost effectiveness study aims to evaluate the effectiveness of surgery on ambulatory care and medication cost compared to the prior conventional conservative treatment.
Materials and methods: A cohort of 20 patients, with a body mass index (BMI) between 25kg/m to 35kg/m and insulin dependent type 2 diabetes mellitus underwent LRYGB. The Diagnosis Related Groups (DRG) related cost of surgery paid by the health insurance (8242.66€ per case 2013) was compared to the cost of the outpatient care and the drug therapy paid by the health insurance pre- and postoperatively. The overall cost of the patient before surgery was compared to the overall cost after the surgery. Data was obtained by requesting the exact cost directly at the health insurance companies. This was possible due to the patients themselves requesting their cost in conformity with §305 Abs. 2 SGB V which states that health insurance companies have to give a patient a complete breakdown of their cost.
Results: Out of 20 Patients 13 patients could be analyzed with sufficient follow-up of at least 12 months. The mean follow-up was 16 months. The average overall outpatient and drug cost before surgery was 4302.63€ (±1795.35€) and was reduced significantly postoperatively to 2302.79€ (±1287.53€; p=0.002). The overall cost decreased 46.5%. The drug cost went down 52,87% with an average annual cost decrease of 1358,27€. The outpatient cost went down 37,23% with an average decreased annual cost of 640,08€. An average of 1999,84€ (±1895.30€) was saved per year after surgery. The breakeven for the surgery will therefore be reached after 4,12 years.
Conclusion: Therefore LRYGB is not only a viable alternative for treating insulin dependent T2DM, but serves also as a major cost saving treatment. Although the small number of patient data records requires an analysis in a larger group of patients.
