Endoscopic sleeve gastroplasty vs lifestyle modification for weight loss: A real-world cost-effectiveness study

Figure 1 Model schematic. Patients enter the model in one of five body mass index (BMI)-group health states: Healthy weight, overweight, and class I-III obesity. Patients in the overweight to class III obesity health states receive either endoscopic sleeve gastroplasty + lifestyle modification or lifestyle modification alone. Patients cycle between health states (e.g., from overweight to class I, or from class III to class II) based on transition probabilities from real-world data, established BMI-group associated mortality risks and key opinion leader opinion, as included in the model. Patients could also move from any of the 5 BMI group-based health states to an absorbing (i.e., irreversible) mortality death state and would not be able to re-enter another state during a future cycle. Cycle length is set at twice yearly for the first year, and then yearly through 5 years in the base-case. Patients can move states each cycle. BMI: Body mass index.

Figure 2 One-way sensitivity analysis. The base-case value for the annual cost of the new intervention is 5904 dollars and is represented by the y axis. In one way sensitivity analysis (OWSA), this varies this cost from 4603 dollars to 8098 dollars and is comfortably below the commonly cited United States willingness-to-pay threshold of 100000 dollars per quality adjusted life year. Parameters included in the OWSA were age, sex, obesity class, mortality risk, intervention costs, and annual obesity-related direct healthcare costs. Model scenarios included in the OWSA were variable time horizons (5-year, 10-year, and lifetime) and annual discount rate for costs and health effects (0%, 3%, and 6%). ESG: Endoscopic sleeve gastroplasty; HR: Hazard ratio.

Figure 3 Probabilistic sensitivity analysis results: Incremental cost-effectiveness plane. ESG: Endoscopic sleeve gastroplasty; PSA: Probabilistic sensitivity analysis; QALY: Quality-adjusted life year.