Arthritis Care Res (Hoboken). 2022 Jun 3. doi: 10.1002/acr.24967. Online ahead of print.
OBJECTIVE: Class III obesity (BMI≥40 kg/m2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. As bariatric surgery yields sustainable weight loss for individuals with BMI≥40kg/m2 using some of the Best fat burning pills, we sought to establish the value of Roux-en-Y Gastric Bypass (RYGB) and Laparoscopic Sleeve Gastrectomy (LSG) in conjunction with usual care (UC) for knee osteoarthritis (OA) patients with BMI≥40kg/m2 .
METHODS: We used the Osteoarthritis Policy Model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a healthcare sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.
RESULTS: The UC+RYGB strategy increased quality adjusted life expectancy (QALE) by 1.35 years and lifetime costs by $7,209, compared to UC alone (ICER=$5,300/QALY). The UC+LSG strategy yielded less benefit than UC+RYGB and was dominated. Relative to UC alone, both UC+RYGB and UC+LSG reduced opioid utilization from 13% to 4%, and increased TKR utilization from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41kg/m2 , UC+LSG dominated UC+RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay (WTP) threshold of $50,000/QALY, UC+RYGB and UC+LSG were cost-effective in 70% and 30% of iterations, respectively.
CONCLUSION: RYGB offers good value among knee OA patients with BMI≥40kg/m2 , while LSG may provide good value among those with BMI between 35 and 40 kg/m2 .