Authors' objectives: This research was carried out in accordance with HIQA’s guidelines for the conduct of HTA. In summary: The Terms of Reference of the HTA were agreed between HIQA and the Clinical Leads for the National Clinical Programmes for Diabetes and Obesity. An Expert Advisory Group was convened by HIQA to inform the assessment with representation from the National Clinical Programme for Diabetes, the National Clinical Programme for Diabetes, the National Clinical Programme for Surgery, the Irish College of General Practitioners (ICGP), clinicians with specialist expertise in diabetes and metabolic disease, methodological experts and relevant patient advocacy groups. The epidemiology of T2D and obesity in Ireland was assessed. A systematic review and meta-analysis of randomised controlled trials (RCTs) was carried out to summarise the best available evidence on the effectiveness and safety of metabolic surgery compared with best medical care or another metabolic surgery. A systematic review of cost-effectiveness was undertaken to summarise the international evidence on the cost-effectiveness of metabolic surgery compared with best medical care. An economic model was developed to estimate the cost-effectiveness and incremental budget impact associated with the proposed introduction of a metabolic surgery programme in Ireland. Finally, the organisational and ethical implications associated with the proposed introduction of the programme were considered.

Authors' recommendations: In patients with comorbid type 2 diabetes and obesity, the current clinical evidence suggests that metabolic surgery is safe, and is more effective than medical care in producing weight loss and improvements in glycaemic control. Metabolic surgery would likely result in a reduced risk of T2D-related complications and a reduction in health service utilisation over the longer term. Even based on conservative assumptions, a metabolic surgery programme provided as part of the T2D clinical care pathway would be an efficient and highly cost-effective use of healthcare resources relative to best medical care. The incremental budget impact was estimated at €7.4 million to provide 1,000 surgeries and follow-up care over five years. While an annual cohort of 200 patients was assumed, the budget impact would be directly proportional to the number of patients undergoing surgery. In the event that metabolic surgery is provided, it should be in the context of a programme including end-to-end care, from referral, pre-operative assessment, the acute surgical care episode through to long-term follow-up. To avoid existing surgical care being displaced, additional staff would be required. The success of a metabolic surgery programme would be dependent on the integration of patient management between primary and secondary care. Development of care pathways that include linkage to hospital and community services would be necessary to support GPs in providing long-term follow-up to these patients. The epidemiology of comorbid T2D and obesity in Ireland is not known with certainty due to the absence of up-to-date, nationally-representative data. Consideration should be given to the establishment of a national diabetes registry to support healthcare service planning in response to epidemiological trends.

Project Status: Completed

URL for project: https://www.hiqa.ie/reports-and-publications/health-technology-assessment/hta-metabolic-surgery-comorbid-t2d-and

URL for protocol: https://www.hiqa.ie/sites/default/files/2022-01/HTA_Protocol_MetabolicSurgery.pdf

Year Published: 2022

URL for published report: https://www.hiqa.ie/sites/default/files/2022-07/HTA%20of%20metabolic%20surgery%20for%20T2D%20and%20obesity.pdf

Requestor: Health Service Executive (HSE)

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Ireland

Organisation Name: Health Information and Quality Authority (HIQA)

Contact Address: Health Information and Quality Authority, George's Court, George's Lane,Smithfield, Dublin 7. PH : + 353 (01) 814 7464

Contact Name: info@hiqa.ie

Contact Email: info@hiqa.ie