الفهرس | Only 14 pages are availabe for public view |
Abstract Health economics is about adoption of the option that achieves maximum value (effective outcome) with the with the least possible cost. Through cost-effectiveness analysis, decision makers both at the national or individual level can develop healthcare related decisions that support the implementation of a cost-effective option that is, the option which achieves the maximum value from the available resources. Over the past decades an evolution of cost-effectiveness importance recognition as a valuable evaluation tool in healthcare has taken place. In the mid 1990s, this evolving importance triggered development of consensus-based recommendations for costeffectiveness analyses implementation in healthcare. Many researchers used costeffectiveness as a valuable tool in assessing healthcare programs and treatment alternatives all over healthcare aspects and domains. As a developing county, Egypt faces many economic challenges. This has been markedly complicated by the political and economic instability since the uprising in 2011. Obesity is a pathological condition that refers to accumulation of excess body fat that may cause several adverse effects on health leading to decreased life expectancy. It is commonly defined by a measurement of Body Mass Index (BMI). BMI is calculated by dividing body weight (kilograms) by height (meters squared). Obesity in adults is most commonly defined as a BMI of 30 kg/m2 or more while morbid obesity is defined as a BMI of 40 kg/m2 or more. Obesity represents a problem with a huge burden on both individuals and societies. It is an increasing problem worldwide. In Egypt 12.7% of males below 20 years were obese compared to 14.4% of females in the same age group while for those above 20 years, 26.4% of males and 48.4% of females were obese. Management of obesity as a chronic healthcare problem usually follows a stepped management approach. It starts by broad lifestyle modification passing through addition of pharmacotherapy as an adjunctive option. Finally, bariatric surgery comes as a third option for more severe cases indicated for that option. Egypt is currently facing low income, increased public debt, and decreased currency value. This renders concepts as cost-effectiveness quite essential. On the other hand, rising rates of obesity in developing countries like Egypt has an association with cheaper prices of high calorie foods. This could be one of the main reason for obesity being a complicated problem in Egypt. Although obesity reached very high levels in Egypt, the urgent need for research on cost-effectiveness studies conducted in the context of obesity treatment options evaluation has been far from fulfilled. The aim of this work is to compare the cost-effectiveness of laparoscopic sleeve gastrectomy versus Orlistat based regimen in treatment of morbidly obese patients attending University Hospitals – Alexandria – Egypt. Summary 50 The study design included both a cross sectional approach employing the Delphi technique by surveying a panel of experts, and a retrospective approach by reviewing medical records of a number of morbidly obese patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) regarding cost and effectiveness. The Delphi panel methodology consists of consensus consultations. The Delphi methodology is based on conducting structured surveys and makes use of the intuitive available information of the participants who are mainly specialists in the field. For assessing both cost and effectiveness of Orlistat-based regimen, we surveyed a panel of four out of a total of five experts included in the weekly schedule in the therapeutic nutrition clinic in the High Institute of Public Health (HIPH), Alexandria University. In the Medical Research Institute hospital in 2015 we found that, on average, LSG cost EGP 25,839 and resulted in a reduction of 14.7 Kg/m2 in BMI (ACER=1,758 EGP/Kg/m2) while OBR cost EGP 10,777 and resulted in a reduction of 5.6 Kg/m2 in BMI (ACER=1,924 EGP/Kg/m2). LSG was more costly but more effective. The average ICER was 1,736 EGP/Kg/m2 ranging from 852 EGP/Kg/m2 to 17,653 EGP/Kg/m2 towards LSG more than Orlistat-based regimen (OBR). This research does represent important steps forward in assessing the cost-effectiveness of two morbid obesity management options. It serves as a valuable decision-making tool on both individual and society level to take actions towards morbid obesity management |