ENDOSCOPIC SLEEVE GASTROPLASTY WITH ENDOMINA DEVICE: THE ECONOMIC IMPACT ON OUR PUBLIC HOSPITAL

Aims Endoscopic bariatric therapies have been developed to treat obesity but no recommendation and no reimbursement exist in France. In our hospital, innovation funding has been validated to used endoscopic sleeve gastroplasty (ESG) technique and 5 to 10 patients a year for two years can be involved. The economic impact of this strategy has to be considered before its regular use.

Methods We estimated the hospital costs of the stays of patients undergoing either an ESG or surgery for a sleeve gastrectomy. Forward-looking micro-costing data in 2019 (staff costs, medical devices and sterilization) and data from a retrospective group of patients who benefited from surgery in 2018 in our hospital (average length of stay, labile blood products or specific drugs administration) and from a group of ESG procedure provided by the manufacturer (duration of the operation) were coupled with data from the French National Cost Study.

Results Practitioners´ feedbacks on these first procedures of ESG are positive and the first results are favorable. The weight loss in percentage of the total weight is 10% after one month (n=3), 15% after 3 months (n=2) and 24% after six months (n=2).

The cost of an ESG stay is estimated at 5945€ (for a one-night stay) and generates an important deficit for our hospital. It is more expensive than the cost of a surgical sleeve stay (4392€). The Endomina device exhibits the majority of the cost (76%).

Conclusions The cost for this new technique is currently higher than for surgery. Only patients with medical contraindication to surgery should benefit from it. Sustainability of this activity will depend on the evolution of procedures and the possible reimbursement of medical devices and medical action. This progression cannot take place without the will of manufacturers and medical societies.