Economic Evaluation of Combined Laparoscopic Hysterectomy with Sleeve Gastrectomy

Background: To evaluate combined laparoscopic hysterectomy (LH) with sleeve gastrectomy (combined surgery) in comparison to LH alone, we performed a cost-effectiveness analysis of combined surgery to assess the lifetime costs and quality-adjusted life years (QALYs) in obese women aged 50-59 with obesity-related disease (ORD) undergoing surgery for atypical endometrial hyperplasia or early-stage endometrial cancer. Methods: A decision-analytic model with lifetime horizon was constructed to compare combined surgery to LH alone. 17 health-state Markov models consisting of no ORD, any combination of four ORDs (diabetes, hypertension, coronary heart disease, stroke), and all four ORDs were used to estimate life expectancy and life-time healthcare costs. Annual probabilities and healthcare costs for women with normal weight, overweight, and obese body mass index were estimated using nationally representative data. Utility weights used to discount life expectancy estimates to calculate QALYs were obtained from published studies. Costs for combined surgery were obtained from a private institution. Costs for LH and surgical complications were abstracted from published studies. All costs were evaluated from the healthcare sector perspective and presented in U.S. dollars at the 2020 price level. Future costs and QALYs were discounted to present values using 3% per year. Results: Life expectancy after combined surgery was 30.7 years and 14.6 QALYs. Post-operative life expectancy after LH was 24.0 years and 11.5 QALYs. The lifetime healthcare costs for patients with combined surgery were $130,366. The lifetime healthcare costs for patients with LH alone were $268,648. Combined surgery dominated LH because it was more effective and less costly than LH. Conclusions: Combined surgery is cost-saving. It is likely to be a viable treatment option for this population. Further study of improving access to combination surgery is warranted.