Long-Term Clinical Outcomes and Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes in Malaysia: A 10-Year Retrospective Cohort Study.
Malaysia has the highest obesity prevalence in Southeast Asia, driving the burden of type 2 diabetes mellitus (T2DM) and its healthcare costs. Long-term real-world cost-effectiveness data on bariatric surgery from Malaysia are absent. We evaluated the clinical outcomes, safety, and exploratory cost-effectiveness of bariatric surgery in Malaysian patients with obesity and T2DM.
Retrospective cohort study of 180 patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass at HCTM, Universiti Kebangsaan Malaysia (2014-2016), with 5-year clinical follow-up. BMI and HbA1c were analysed using generalised estimating equations (GEE) with a Gaussian family, identity link and exchangeable working correlation. An exploratory cost-effectiveness analysis compared 20 surgical patients with 20 matched conventional-management patients (2012-2014) over a 10-year horizon from the healthcare-payer perspective. The incremental cost-effectiveness ratio (ICER) was expressed per 1% HbA1c reduction, with one-way deterministic and probabilistic sensitivity analyses.
Mean BMI decreased from 49.29 ± 8.97 to 25.33 ± 4.25 kg/m2 at 5 years; HbA1c fell from 6.37 ± 1.37% to 5.62 ± 0.68% (both GEE p<0.001). The complication rate was 2.2%, and 76% of patients were discharged ithin 2 days. The base-case ICER was RM 4683 per 1% HbA1c reduction; probabilistic analysis yielded a median ICER of RM 4828 (95% credible interval: cost-saving to RM 32,286) and a 59% probability of cost-effectiveness at a willingness-to-pay threshold of RM 7500 per 1% HbA1c reduction.
In this single-centre Malaysian cohort, bariatric surgery produced durable improvements in BMI and HbA1c with low complication rates and a favourable exploratory ICER. Findings should be interpreted in light of the retrospective design and small economic cohort, and confirmed in multicentre prospective studies.
Retrospective cohort study of 180 patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass at HCTM, Universiti Kebangsaan Malaysia (2014-2016), with 5-year clinical follow-up. BMI and HbA1c were analysed using generalised estimating equations (GEE) with a Gaussian family, identity link and exchangeable working correlation. An exploratory cost-effectiveness analysis compared 20 surgical patients with 20 matched conventional-management patients (2012-2014) over a 10-year horizon from the healthcare-payer perspective. The incremental cost-effectiveness ratio (ICER) was expressed per 1% HbA1c reduction, with one-way deterministic and probabilistic sensitivity analyses.
Mean BMI decreased from 49.29 ± 8.97 to 25.33 ± 4.25 kg/m2 at 5 years; HbA1c fell from 6.37 ± 1.37% to 5.62 ± 0.68% (both GEE p<0.001). The complication rate was 2.2%, and 76% of patients were discharged ithin 2 days. The base-case ICER was RM 4683 per 1% HbA1c reduction; probabilistic analysis yielded a median ICER of RM 4828 (95% credible interval: cost-saving to RM 32,286) and a 59% probability of cost-effectiveness at a willingness-to-pay threshold of RM 7500 per 1% HbA1c reduction.
In this single-centre Malaysian cohort, bariatric surgery produced durable improvements in BMI and HbA1c with low complication rates and a favourable exploratory ICER. Findings should be interpreted in light of the retrospective design and small economic cohort, and confirmed in multicentre prospective studies.
Authors
Galvan Galvan, Loo Loo, Kosai Kosai, Yeong Yeong, Chinna Chinna, Nordin Nordin, Lee Lee, Mustafa Mustafa
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