Annals of medicine and surgery (2012) · 2026
Cost-effectiveness analysis of FundoRing versus standard one-anastomosis gastric bypass: up to 3-year results of a randomized controlled trial.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ospanov Oral, Duysenov Galymjan, Yelembayev Bakhtiyar, Yeleuov Galymzhan, Dildbekov Zhanbolat
Аннотация
BACKGROUND: The FundoRing modification of one-anastomosis gastric bypass (OAGB) has demonstrated superior clinical outcomes compared with standard OAGB in patients with metabolic syndrome. However, the cost-effectiveness of this innovative technique remains unclear. This study aimed to perform a cost-effectiveness analysis of FundoRing versus standard OAGB using the incremental cost-effectiveness ratio (ICER) and the cost-effectiveness plane.
METHODS: A cost-effectiveness analysis was conducted alongside a randomized controlled trial including 1000 patients (n = 500 FundoRing, n = 500 standard OAGB) with metabolic syndrome and up to 3 years of follow-up (median: 28 months, IQR: 22-34 months). Effectiveness was measured as the proportion of patients who achieved a target BMI of <30 kg/m2 at their last follow-up visit. Direct medical costs, including surgical intervention, hospitalization, postoperative follow-up, and management of late complications, were calculated from the healthcare-system perspective. Costs were converted from the Kazakhstani tenge (KZT) to US dollars (USD) using the 2025 exchange rate (521.59 KZT/USD). The willingness-to-pay (WTP) threshold was used as a contextual benchmark, with the understanding that the primary conclusion on cost-effectiveness relies on the dominance finding. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs divided by the difference in effectiveness. A probabilistic sensitivity analysis with 5000 bootstrap iterations was performed to construct the cost-effectiveness plane.
RESULTS: At the last follow-up (median 28 months), the FundoRing group demonstrated significantly higher effectiveness (94.2% vs. 86.7% achieving BMI <30 kg/m2; P = 0.002) and significantly lower total costs per patient (5928.10 USD vs. 6758.00 USD, difference -829.90 USD, 95% CI: -1184.2 to -475.6). The cost savings in the FundoRing group were primarily driven by a reduced incidence of late complications such as dumping syndrome (13.7% vs. 36.5%; P < 0.001), marginal ulcers (0.2% vs. 2.9%; P < 0.001), and bile reflux esophagitis (0.2% vs. 8.1%; P < 0.001). The ICER was -11 065 USD per patient achieving the target BMI. On the cost-effectiveness plane, 100% of the bootstrap iterations fell in the southeast quadrant, indicating that FundoRing is a dominant strategy (lower costs and higher effectiveness).
CONCLUSION: FundoRing modification of OAGB is a more cost-effective strategy than standard OAGB within the studied population and single-center setting. The reduction in late postoperative complications generates substantial healthcare savings while achieving superior clinical outcomes. These findings provide economic evidence to support the use of the FundoRing technique in bariatric surgery. Multi-center studies are needed to confirm generalizability.
METHODS: A cost-effectiveness analysis was conducted alongside a randomized controlled trial including 1000 patients (n = 500 FundoRing, n = 500 standard OAGB) with metabolic syndrome and up to 3 years of follow-up (median: 28 months, IQR: 22-34 months). Effectiveness was measured as the proportion of patients who achieved a target BMI of <30 kg/m2 at their last follow-up visit. Direct medical costs, including surgical intervention, hospitalization, postoperative follow-up, and management of late complications, were calculated from the healthcare-system perspective. Costs were converted from the Kazakhstani tenge (KZT) to US dollars (USD) using the 2025 exchange rate (521.59 KZT/USD). The willingness-to-pay (WTP) threshold was used as a contextual benchmark, with the understanding that the primary conclusion on cost-effectiveness relies on the dominance finding. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs divided by the difference in effectiveness. A probabilistic sensitivity analysis with 5000 bootstrap iterations was performed to construct the cost-effectiveness plane.
RESULTS: At the last follow-up (median 28 months), the FundoRing group demonstrated significantly higher effectiveness (94.2% vs. 86.7% achieving BMI <30 kg/m2; P = 0.002) and significantly lower total costs per patient (5928.10 USD vs. 6758.00 USD, difference -829.90 USD, 95% CI: -1184.2 to -475.6). The cost savings in the FundoRing group were primarily driven by a reduced incidence of late complications such as dumping syndrome (13.7% vs. 36.5%; P < 0.001), marginal ulcers (0.2% vs. 2.9%; P < 0.001), and bile reflux esophagitis (0.2% vs. 8.1%; P < 0.001). The ICER was -11 065 USD per patient achieving the target BMI. On the cost-effectiveness plane, 100% of the bootstrap iterations fell in the southeast quadrant, indicating that FundoRing is a dominant strategy (lower costs and higher effectiveness).
CONCLUSION: FundoRing modification of OAGB is a more cost-effective strategy than standard OAGB within the studied population and single-center setting. The reduction in late postoperative complications generates substantial healthcare savings while achieving superior clinical outcomes. These findings provide economic evidence to support the use of the FundoRing technique in bariatric surgery. Multi-center studies are needed to confirm generalizability.