Health Technology Assessment (HTA) of Roux-en-Y Gastric Bypass compared to Sleeve Gastrectomy in Obese Type 2 Diabetic Adults
Dr. Joseph Jackson, Capstone Advisor
Dr. Robert Lieberthal, Second Reader
The purpose of this project was to assess the value of Laproscopic Roux-en-Y Gastric Bypass (RYGB) as a treatment option in obese type 2 diabetic adults in comparison to Laparoscopic Sleeve Gastrectomy (SG). A search of the biomedical literature (2008-14) for studies comparing RYGB and SG and the effectiveness of RYGB in the treatment of obese type 2 diabetics was conducted. RYGB and SG showed statistically significantly greater weight loss, glycemic control, and diabetes remission rates than medical treatment in combination with life-style modifications. Clinical and observational studies reported statistically significant long-term favorable outcomes for RYGB compared to SG. These included bodyweight reduction, glycemic control, diabetes remission, lower diabetes relapse, lower diabetes medication use, and lower overall medication use. Bariatric quality of life, health and activities index, and patient satisfaction were also statistically significantly higher for RYGB patients. Overall complication rates were higher in RYGB than SG but there were no statistically significant differences for major complication between the two procedures. Diabetes remission was related to body mass index reduction and to the duration of diabetes. No cost-effectiveness studies of SG in comparison to RYGB were identified but RYGB cost-effectiveness studies versus laparoscopic adjustable gastric banding were used to demonstrate the cost-effectiveness of RYGB and to make a qualitative assessment of RYGB and SG. Conclusions: Bariatric surgery is the most effective option for the morbidly obese for losing weight and countering obesity-related type 2 diabetes. Among common bariatric procedures with acceptable safety profiles, RYGB provides the greatest effectiveness in long-term weight loss and diabetes remission. The cost-effectiveness of RYGB is below the commonly used willingness to pay threshold of $50,000/QAL, especially for longer time horizons.
Presentation: 39 minutes