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

Table 1 Key model parameters

Parameter		Parameter value	Distribution	Source
Clinical	Baseline characteristics
	Age (years), mean (SE)	46 (N/A)	N/A
	Male sex,% (SE)	14.4 (3)	Beta
	Class I obesity, n (%)	48 (29)
	Class II obesity, n (%)	58 (37)
	Class III obesity, n (%)	53 (34)	N/A
	Mortality risk, HR (SE)		Gamma
	Healthy weight	1.00 (reference)
	Overweight	1.08 (0.03)
	Obesity I	1.27 (0.01)
	Obesity II	1.93 (0.01)
	Obesity III1	1.93 (0.03)
Utility	Utility, mean (SE)		Beta
	Healthy weight	0.88 (0.001)
	Overweight	0.81 (0.002)
	Obesity I	0.78 (0.030)
	Obesity II	0.70 (0.030)
	Obesity III	0.61 (0.040)
Costs (dollars)	Intervention costs, mean (SE)		N/A	Data on file
	One-off ESG device and procedure costs2	13671.27 (N/A)
	Annual LM costs	586.72 (N/A)
	Annual obesity-related direct healthcare costs, mean (SE)3		Gamma
	Healthy weight	2963.94 (592.79)
	Overweight4	2963.94 (592.79)
	Obesity I	5032.70 (1006.54)
	Obesity II	6566.56 (1313.31)
	Obesity III	9903.66 (1980.73)

¹Hazard ratio was not reported by Xu et al[26] for the body mass index range equivalent to the obesity III health state and was conservatively assumed to be the same as that in the obesity II health state.

²Includes device costs, surgical supply costs, drug costs, facility use (operating room, recovery room, and labor) costs, and endoscopic sleeve gastroplasty imaging (diagnostic esophagoscopy) costs.

³2017 cost year inflated to 2023 dollars values using the National Consumer Price Index.

⁴Costs were not reported for the body mass index range equivalent to the overweight health state and were assumed to be the same as the value reported by Cawley et al[28] for the healthy weight health state.

ESG: Endoscopic sleeve gastroplasty; HR: Hazard ratio; N/A: Not applicable.

Table 2 Deterministic base-case and obesity subgroup results

	Costs (dollars)	Life years	QALYs	ICER (dollars/QALY)
Overall
ESG	34579	4.786	3.662
LM	32619	4.778	3.330
Incremental (ESG vs LM)	1960	0.007	0.332	5904
Class I obesity
ESG	32712	4.791	4.122
LM	29383	4.788	3.881
Incremental (ESG vs LM)	3329	0.004	0.241	13813
Class II obesity
ESG	33751	4.788	3.720
LM alone	30828	4.777	3.362
Incremental (ESG vs LM)	2923	0.011	0.358	8158
Class III obesity
ESG	39945	4.779	3.419
LM	39699	4.773	3.047
Incremental (ESG vs LM)	276	0.006	0.371	743

ESG: Endoscopic sleeve gastroplasty; ICER: Incremental cost-effectiveness ratio; LM: Lifestyle modification; QALY: Quality-adjusted life year.

Table 3 Key scenario analysis results

	Costs (dollars)	Life years	QALYs	ICER (dollars/QALY)
Base-case results
ESG	34579	4.786	3.662
LM alone	32619	4.778	3.330
Incremental (ESG vs LM)	1960	0.007	0.332	5904
Scenario 1: 10-year time horizon
ESG	57324	8.855	6.763
LM	61766	8.811	6.149
Incremental (ESG vs LM)	-4442	0.044	0.614	ESG dominant1
Scenario 2: Lifetime time horizon2
ESG	126638	21.401	16.351
LM	143558	20.245	14.153
Incremental (ESG vs LM)	-16920	1.156	2.198	ESG dominant1
Scenario 3: 6% discounting rate
ESG	33723	4.618	3.533
LM	31334	4.611	3.214
Incremental (ESG vs LM)	2389	0.007	0.318	7502
Scenario 4: 0% discounting rate
ESG	35521	4.970	3.805
LM	34028	4.962	3.458
Incremental (ESG vs LM)	1493	0.008	0.347	4.304

¹Endoscopic sleeve gastroplasty results in both cost savings and higher quality-adjusted life years compared with lifestyle modification alone.

²The duration of the lifetime horizon was 54 years, based on 100 years minus the mean age at baseline (46 years).

ESG: Endoscopic sleeve gastroplasty; ICER: Incremental cost-effectiveness ratio; LM: Lifestyle modification; QALY: Quality-adjusted life year.