Cost-Effectiveness Of Endoscopic Sleeve Gastroplasty Using A Disease Progression Model

Background The clinical efficacy of endoscopic sleeve gastroplasty (ESG) is well-established, yet evidence on its cost-effectiveness is limited. Objectives This analysis assessed the lifetime cost-effectiveness of ESG and lifestyle management (ESG+LM) compared with LM alone in ESG-eligible patients. Setting Singapore health system perspective. Methods We developed a Markov model to simulate the incidence of type 2 diabetes (T2D), stroke, myocardial infarction (MI) and cardiovascular death. Disease risks were modelled as functions of age, sex, and key clinical risk factors. For each intervention arm, we simulated annual transitions between disease states, tracking associated healthcare costs and quality-adjusted life-years (QALYs), both of which were discounted at an annual rate of 3%, over a lifetime horizon. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the robustness of the results to changes in key model parameters. Results The average cost of the ESG procedure in Singapore was SG$ 14,145 (US$ 10,590). In the base case (lifetime horizon), ESG+LM cost SG$ 9,110 (US$ 6,820) more and accrued 0.37 more QALYs than LM, generating an incremental cost-effectiveness ratio (ICER) of SG$ 24,580/QALY (US$ 18,410/QALY). The ICER for patients without T2D was SG$ 19,320/QALY (US$ 14,470/QALY). The ICER for patients with T2D was SG$ 37,320/QALY (US$ 27,950/QALY). At SG$ 75,000/QALY (US$ 56,170/QALY) threshold, ESG+LM was cost-effective in 98.8% of the PSA iterations. Conclusion Over a lifetime horizon, ESG+LM is likely cost-effective for treating obesity in Singapore and may merit subsidy consideration for eligible patients.