Endoscopic sleeve gastroplasty versus lifestyle modifications for class II obesity patients: a French...

Obesity is a worldwide epidemic, with up to 17% of French population affected. European guidelines recommend surgical management at specific weight and comorbidity level; however, less than 2% of eligible patients undergo surgical bariatric interventions. To extend the benefits of bariatric interventions to the untreated population with obesity, endoscopic techniques such as endoscopic sleeve gastroplasty (ESG) have been developed. Analysis of costs and long-term benefits of ESG across stakeholders is needed. This work aimed to assess the healthcare economic and outcomes for ESG in the French healthcare system.

A cost-utility analysis study was conducted to evaluate class II obesity patients, stratified into ESG and lifestyle modifications or lifestyle modifications alone groups. Health benefits were measured as quality-adjusted life years (QALY) and costs benefits expressed as incremental cost-effectiveness ratio (ICER). A 6-state Markov model was used and base case scenario analysis was used to assess ESG benefits against lifestyle modifications only. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis were performed to evaluate uncertainty on health care interventions and worse case scenarios, respectively.

ESG population from the France center included 59 patients, lifestyle modification group was drawn from the MERIT cohort. The base case scenario showed higher costs for ESG procedure compared to lifestyle modifications alone; however, gain in terms of QALY (+ 1,3) is observed maintaining ICER below the set threshold. Also OWSA and probabilistic analysis confirmed ESG cost-effectiveness. OWSA allowed identification of ICER-influencing factors; probabilistic sensitivity analysis confirmed ESG to be cost-effective in 99.29% of iterations.

ESG is cost-effective in the French healthcare system. Its potential to reach an untreated portion of the population living with obesity should prompt its uptake into clinical practice. The results of this study should sustain ESG implementation throughout France and possible integration of its reimbursement by the public healthcare system.