2024-이식전 비만환자에 대한 체중감량과 경제효과
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2024-이식전 비만환자에 대한 체중감량과 경제효과
Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-
1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates
with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness,
risk profiles, and costs make strategy choices challenging. To aid decisionmaking,
we used a Markov model to examine the cost-effectiveness of different WL strategies
over a 10-year horizon. A target WL of 15% of total body weight was used for the
base case scenario, and we compared these strategies to a “liberal” KT strategy of
transplanting candidates with obesity. Outcomes included costs (2023 US dollars), qualityadjusted
life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT
strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies,
bariatric surgery was the most effective and cost the least, whereas lifestyle modification
had the highest cumulative costs and was the least effective. Compared to liberal KT,
bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were
favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric
surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes
and cost-effectiveness.
Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-
1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates
with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness,
risk profiles, and costs make strategy choices challenging. To aid decisionmaking,
we used a Markov model to examine the cost-effectiveness of different WL strategies
over a 10-year horizon. A target WL of 15% of total body weight was used for the
base case scenario, and we compared these strategies to a “liberal” KT strategy of
transplanting candidates with obesity. Outcomes included costs (2023 US dollars), qualityadjusted
life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT
strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies,
bariatric surgery was the most effective and cost the least, whereas lifestyle modification
had the highest cumulative costs and was the least effective. Compared to liberal KT,
bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were
favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric
surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes
and cost-effectiveness.
