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The American Journal of Managed Care August 2017
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Cost-Effectiveness Analysis of Vagal Nerve Blocking for Morbid Obesity
Jeffrey C. Yu, AB; Bruce Wolfe, MD; Robert I. Griffiths, ScD, MS; Raul Rosenthal, MD; Daniel Cohen, MA; and Iris Lin, PhD
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Cost-Effectiveness Analysis of Vagal Nerve Blocking for Morbid Obesity

Jeffrey C. Yu, AB; Bruce Wolfe, MD; Robert I. Griffiths, ScD, MS; Raul Rosenthal, MD; Daniel Cohen, MA; and Iris Lin, PhD
This lifetime economic analysis demonstrates vagal nerve blocking therapy to be a cost-effective alternative to conventional therapy in class 2 and 3 obesity patients.
This analysis provides a cost-effectiveness evaluation of a new weight loss therapy that may present an affordable and minimally invasive option for patients seeking alternatives to currently available weight loss treatments. Recent cost-effectiveness analyses in bariatric surgery have compared bariatric surgical options such as LAGB and LRYGB versus no treatment.22,29 The designs of these previous models have informed this model’s design for capturing the impact of BMI class and diabetes remission on costs, clinical outcomes, and cost-effectiveness.

Our findings suggest that vagal nerve blocking therapy is likely to be a cost-effective alternative to conventional therapy among class 2 patients with diabetes and class 3 patients with or without diabetes. ICERs from base-case and sensitivity analyses fell below $30,000 per QALY gained, suggesting that vagal nerve blocking therapy represents good value for money from a US payer perspective. 

Author Affiliations: Boston Health Economics, Inc (JCY, RIG, IL), Waltham, MA; Oregon Health & Science University (BW), Portland, OR; Cleveland Clinic Florida (RR), Weston, FL; EnteroMedics, Inc (DC), St. Paul, MN.

Source of Funding: This study was funded by EnteroMedics, Inc.

Author Disclosures: Mr Yu and Dr Lin are employees of, and Dr Griffiths is a consultant to, Boston Health Economics, Inc, which consulted for EnteroMedics, Inc. Mr Cohen is employed by, and owns stock in, EnteroMedics. Dr Wolf received a contract from EnteroMedics to conduct the ReCharge study. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JCY, RIG, DC, IL); acquisition of data (JCY); analysis and interpretation of data (JCY, RIG, DC, IL); drafting of the manuscript (JCY, BW, RIG, RR, DC, IL); critical revision of the manuscript for important intellectual content (JCY, BW, RIG, RR, DC, IL); statistical analysis (JCY, RIG, IL); provision of patients or study materials (DC); obtaining funding (DC); administrative, technical, or logistic support (JCY); and supervision (JCY, BW, RIG, RR, IL).

Address Correspondence to: Iris Lin, PhD, Boston Health Economics, 20 Fox Rd, Waltham, MA 02451. E-mail: 

1. Shields M, Carroll MD, Ogden CL. Adult obesity prevalence in Canada and the United States. NCHS Data Brief. 2011;(56):1-8.

2. Wing RR, Bolin P, Brancati FL, et al; The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. doi: 10.1056/NEJMoa1212914.

3. Bray GA. Medications for weight reduction. Med Clin North Am. 2011;95(5):989-1008. doi: 10.1016/j.mcna.2011.06.009.

4. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1-190, 215-357, iii-iv. doi: 10.3310/hta13410.

5. Behary J, Kumbhari V. Advances in the endoscopic management of obesity. Gastroenterol Res Pract. 2015;2015:757821. doi: 10.1155/2015/757821.

6. Stevens J, Oakkar EE, Cui Z, Cai J, Truesdale KP. US adults recommended for weight reduction by 1998 and 2013 obesity guidelines, NHANES 2007-2012. Obesity. 2015:23(3):527-531. doi: 10.1002/oby.20985.

7. Kumbhari V, Oberbach A, Nimgaonkar A. Primary endoscopic therapies for obesity and metabolic diseases. Curr Opin Gastroenterol. 2015;31(5):351-358. doi: 10.1097/MOG.0000000000000203.

8. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62-70. doi: 10.1001/jama.2014.16968.

9. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff. 2009;28(5):w822-w831. doi: 10.1377/hlthaff.28.5.w822.

10. Ikramuddin S, Blackstone RP, Brancatisano A, et al. Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial [erratum in JAMA. 2015;313(1):95]. JAMA. 2014;312(9):915-922. doi: 10.1001/jama.2014.10540.

11. Berthoud H. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20(supp1):64-72. doi: 10.1111/j.1365-2982.2008.01104.x.

12. Papasavas P, El Chaar M, Kothari SN; America Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery position statement on vagal blocking therapy for obesity. Surg Obes Relat Dis. 2016;12(3):460-461. doi: 10.1016/j.soard.2015.12.004.

13. ORBERA nonsurgical weight loss balloon system. Orbera website. Accessed June 10, 2016.

14. ReShape Weight Loss Balloon System. ReShape Medical website. Accessed July 5, 2017.

15. Cobourn C, Degboe A, Super PA, et al. Safety and effectiveness of LAP-BAND AP System: results of Helping Evaluate Reduction in Obesity (HERO) prospective registry study at 1 year. J Am Coll Surg. 2013;217(5):907-918. doi: 10.1016/j.jamcollsurg.2013.06.010.

16. Hamdan K, Somers S, Chand M. Management of late postoperative complications of bariatric surgery. Br J Surg. 2011;98(10):1345-1355. doi: 10.1002/bjs.7568.

17. New procedure estimates for bariatric surgery: what the numbers reveal. American Society for Metabolic and Bariatric Surgery website. Accessed June 10, 2016.

18. O’Hagan A, Stevenson M, Madan J. Monte Carlo probabilistic sensitivity analysis for patient level simulation models; efficient estimation of mean and variance using ANOVA. Health Econ. 2007;16(10):1009-1023.

19. Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):148-1503.

20. Arterburn DE, Maciejewski ML, Tsevat J. Impact of morbid obesity on medical expenditures in adults. Int J Obes. 2005;29(3):334-339.

21. Gregg EW, Chen H, Wagenknecht LE, et al; Look AHEAD Research Group. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489-2496. doi: 10.1001/jama.2012.67929.

22. Campbell J, McGarry LJ, Shikora SA, Hale BC, Lee JT, Weinstein MC. Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity. Am J Manag Care. 2010;16(7):e174-e187.

23. Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861-1867.

24. Arias E. National Vital Statistics Reports: United States life tables, 2010. CDC website. Published November 6, 2014. Accessed May 1, 2015.

25. Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied Methods of Cost-Effectiveness Analysis in Healthcare. 1st ed. New York, NY: Oxford University Press; 2010.

26. Beck JR, Pauker SG, Gottlieb JE, Klein K, Kassirer JP. A convenient approximation of life expectancy (the “DEALE”): II. Use in medical decision-making. Am J Med. 1982;73(6):889-897.

27. Comay D, Adam V, da Silveira EB, Kennedy W, Mayrand S, Barkun AN. The Stretta procedure versus proton pump inhibitors and laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a cost-effectiveness analysis. Can J Gastroenterol. 2008;22(6):552-558.

28. Simoens S. How to assess the value of medicines? Front Pharmacol. 2010;1(115). doi: 10.3389/fphar.2010.00115.

29. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933-1939. doi: 10.2337/dc10-0554.  
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