背景:转换代谢和减肥手术(CMBS)的需求仍在增长。没有大规模的前瞻性队列研究评估CMBS后降脂治疗(LLT)的变化。
目的:本研究评估并比较了袖状胃切除术(SG)和可调节胃束带术(AGB)后4种主要CMBS序列对LLT报销和费用的有效性。
方法:法国。
方法:这项全国性的基于人群的观察性队列研究分析了来自法国国家健康保险数据库的数据。它包括2012年1月1日至2014年12月31日在法国接受过原发性SG和AGB的所有患者,随访至2020年12月31日。该研究评估了4种不同CMBS序列的LLT报销演变和成本。
结果:随访期间,6396例患者接受了4个CMBS序列:SG-RYGB(Roux-en-Y胃旁路术)(n=2400),AGB-SG(n=2277),AGB-RYGB(n=1173),和SG-SG(n=546),LLT报销率为9.8%,3.6%,6.6%,和7.9%,分别,在CMBS前一年。2年和4年停药率为41.9%,35.4%,45.6%,20.5%和45.6%,31.3%,64.3%,31.6%,分别。四年后,每个患者的中位数[四分位数范围]年费用(欧元)显着低于(P<.01)CMBS前一年每个序列的费用:86.8[57.3;136.1]对38.0[.0;64.6],79.1[50.5;120.1]对50.4[15.6;64.1],89.0[66.5;139.6]对.0[.0;58.8],和89.8[66.1;121.4]对63.1[.0;93.4]。
结论:我们的研究强调了CMBS在4年内显著降低血脂异常患者LLT需求和相关成本的有效性。
BACKGROUND: The need for conversional metabolic and bariatric surgery (CMBS) is still growing. No large-scale prospective cohort studies have assessed changes in lipid-lowering treatment (LLT) after CMBS.
OBJECTIVE: This study assesses and compares the effectiveness of the 4 main CMBS sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) on reimbursement and cost of LLT.
METHODS: France.
METHODS: This nationwide observational population-based cohort study analyzed data from the French National Health Insurance database. It included all patients who had undergone primary SG and AGB in France between January 1, 2012, and December 31, 2014, and followed until December 31, 2020. The study assessed LLT reimbursement evolution and costs across 4 different CMBS sequences.
RESULTS: During follow-up, 6396 patients underwent the 4 CMBS sequences: SG-RYGB (Roux-en-Y gastric bypass) (n = 2400), AGB-SG (n = 2277), AGB-RYGB (n = 1173), and SG-SG (n = 546), with a rate of LLT reimbursement of 9.8%, 3.6%, 6.6%, and 7.9%, respectively, in the year before CMBS. The rates of discontinuation of treatment at 2 and 4 years were 41.9%, 35.4%, 45.6%, 20.5% and 45.6%, 31.3%, 64.3%, 31.6%, respectively. At 4 years, the median [interquartile range] annual costs (euros) per patient were significantly lower (P < .01) than the costs in the year before CMBS for each sequence: 86.8 [57.3; 136.1] versus 38.0 [.0; 64.6], 79.1 [50.5; 120.1] versus 50.4 [15.6; 64.1], 89.0 [66.5; 139.6] versus .0 [.0; 58.8], and 89.8 [66.1; 121.4] versus 63.1 [.0; 93.4].
CONCLUSIONS: Our study underlines the effectiveness of CMBS in significantly reducing the need and associated costs of LLT for patients with dyslipidemia over a 4-year period.