SHORT TERM COST SAVINGS WITH ENDOSCOPIC SLEEVE GASTROPLASTY; A 30 DAY US COST CONSEQEUNCE ANALYSIS.
Erik B. Wilson*1, Frank O'Neill2, Brandon VanderWel4, Mason R. Witherow3, Timothy D. Kofol3, Michael Ujiki5
1The University of Texas Health Science Center at Houston, Houston, TX; 2Apollo Endosurgery, Inc., Austin, TX; 3S2N Health, Boston, MA; 4Eviva Health, Shoreline, WA; 5NorthShore University HealthSystem, Evanston, IL
Background: Endoscopic sleeve gastroplasty (ESG) is a less invasive alternative to laparoscopic sleeve gastrectomy (LSG) for bariatric intervention in patients. Recent propensity matched analyses have demonstrated non-inferior weight loss for ESG compared to LSG analyses, with comparable adverse event rates. However, there is a lack of comparative costing data to inform clinical and economic decision making.
Aim: To compare short-term costs between ESG and LSG in US patients undergoing bariatric intervention.
Material & Methods: A cost-consequence model was developed to simulate procedural and adverse event cost up to 30 days. Clinical and cost parameters were informed using commercial US claims databases, targeted literature review and expert opinion.
Results: A significantly greater amount of ESG procedures took place in the outpatient setting (p<0.01). ESG was associated with a reduction in costs ($4,452 per patient) at 30 days, compared to LSG. Savings were driven by a reduced OR time ($871) and Length of stay ($2,776) between the procedures. After 30 days there was an increased incidence of gastroesophageal reflux disease (6.6%) in the LSG compared to ESG (0.4) (p<0.01). All other adverse events contributed to a cost saving with ESG after 30 days.
Conclusion: In our analysis, ESG is cost-saving compared to LSG and may offer economic benefits for selected US bariatric patients. Cost-saving were due to procedure setting and reduction in facility resource utilisation at 30 days. Well conducted and longer-term costing studies are required to inform robust economic modelling and clinical decision making.
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