Background

Obesity impacts nearly 42% of United States (US) adults and incurs costs of more than $700 billion US Dollars (USD) annually (2019 estimate). Endoscopic sleeve gastroplasty (ESG) is an FDA-authorized incisionless procedure with an excellent safety, efficacy, and durability profile. In this study, we estimate the cost-effectiveness of ESG versus lifestyle modification (LM) in a real-world population of US adults with class III obesity.

Methods

A 6-state Markov model including 5 BMI-based health states and an absorbing death state was utilized. Clinical inputs for ESG were taken from a single-center, real-world US database, and inputs for LM were derived from clinical literature. 6-month cycles were used in the first year and annual cycles thereafter, with a 5-year horizon. Estimates of utility for each health state, disutilities for adverse events, and the incidence of obesity-related comorbidities were based on clinical literature. One-way and probabilistic sensitivity analyses were performed, and costs were reported as 2023 USD.

Results

53 patients with class III obesity were analyzed. The base-case incremental cost-effectiveness ratio (ICER) for ESG versus LM was $743/QALY, well below established willingness to pay thresholds ($100,000/QALY) (Figure 1). ESG dominated LM in one-way and scenario analyses, with no ICER exceeding $1,375. Probabilistic sensitivity analyses suggested cost-effectiveness of ESG in over 99% of simulations.

Conclusions

ESG is highly cost-effective in class III obesity. Physicians should offer ESG as an option to patients seeking incisionless obesity treatment, and payers may find the cost-effectiveness of ESG sufficient to increase coverage for their members.