The value of metabolic surgery for patients with obesity and type 2 diabetes in Romania

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Background: Metabolic surgery is a well-established intervention for managing severe obesity and type 2 diabetes, offering significant long-term health benefits. In Europe, procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass have been shown to improve glycemic control, reduce obesity-related comorbidities, and enhance quality of life. Given the high prevalence of obesity in Romania, evaluating the cost-effectiveness of these surgical interventions is crucial for potential public funding inclusion. Methods: ) and tracked outcomes over a lifetime horizon. Cost and quality-adjusted life years were evaluated for sleeve gastrectomy and Roux-en-Y gastric bypass using two costing methodologies: Diagnosis-Related Group-based reimbursement and micro-costing analysis. Scenario analyses, including threshold analysis, were conducted to validate model robustness. Results: Obesity surgery was found to be a dominant strategy, yielding both cost savings and improved health outcomes across all Body Mass Index categories. The intervention led to increased life expectancy, reduced diabetes-related complications, and a significant reduction in healthcare costs. Even under conservative cost assumptions, the surgery remained cost-effective, with an Incremental Cost-Effectiveness Ratio (ICER) well within European funding thresholds. Conclusion: The results support the inclusion of metabolic surgery in Romania's public healthcare system. Expanding access could reduce long-term healthcare expenditures while improving the quality of life for individuals with obesity and type 2 diabetes.

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