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

BACKGROUND: Obesity impacts 42% of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually. Endoscopic sleeve gastroplasty (ESG) is a United States Food and Drug Administration authorized procedure with an excellent safety, efficacy, and durability profile. The cost-effectiveness of ESG compared to lifestyle modification (LM) in real-world patients with class I-III obesity represents a critical knowledge gap. AIM: LM using a real-world dataset of 860 United States adults with class I-III obesity undergoing ESG. METHODS: A 6-state Markov model was employed, including healthy weight, overweight, class I-III obesity, and death. The LM control group was built using transition states previously described in the literature, supplemented by expert opinion. Cycles lasted six-months in the model's first year and twelve-months thereafter. Existing literature informed approximations of each health state utility, adverse event disutility, and incidence of obesity-associated comorbidities. One-way sensitivity and probabilistic sensitivity analyses were performed. RESULTS: LM was 5904 dollars per quality-adjusted life year (QALY). In a one-way sensitivity analysis, the utilities assigned to the three obesity classes most greatly influenced the ICER. Probabilistic sensitivity analysis estimated an increase in upper-bound ICER of 8038 dollars per QALY, well under the generally cited United States willingness to pay ratio of 100000 dollars per QALY. CONCLUSION: The results of this model support that ESG is overwhelmingly cost-effective compared to LM across all obesity classes. Payors should consider expanding coverage for their members.