Endoscopic Sleeve Gastrectomy for Weight Loss Has Significant Value Benefit over Semaglutide, Study Suggests
Haseeb M, Chhatwal J, Xiao J, et al. Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss. JAMA Netw Open. 2024;7(4):e246221.
Endoscopic sleeve gastrectomy (ESG) is associated with excellent long-term control of obesity, improvements in comorbid conditions, and reduction of the significant obesity-associated socioeconomic burdens. New weight loss medications such as glucagon-like receptor agonists (semaglutide) that were originally developed for treatment of diabetes have shown efficacy as well, but the cost effectiveness of this treatment has not been confirmed.
This article reported data from a Markov model study that estimated a cost comparison of the two treatments using standard statistical methods. The study directly compared costs of ESG (including estimated mortality and complications) with costs of semaglutide over a 5-year interval using published outcomes data. The main measures of interest were costs, quality of life years (QALY), and incremental cost effectiveness ratio (ICER).
The analysis showed that ESG was significantly more cost effective than semaglutide. ESG resulted in greater weight loss at lower cost. For semaglutide to be equally cost effective, its price would need to be reduced from the current cost ($13,618/year) to $359/year. Additional long-term outcomes data will be needed to confirm the validity of these findings.
Study Examines Optimal Peripheral Intravenous Catheter Securement for Children
Charters B, Foster K, Lawton B, et al. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr. 2024.
Bettencourt A, Ruppel H, Bonafide CP. Advancing Evidence-Based Peripheral Intravenous Catheter Securement. JAMA Pediatr. 2024.
Failure of peripheral IV placement in children occurs in up to 33% of patients. Charters and coauthors reported a prospective randomized trial comparing three forms of peripheral IV securement:
- Standard care-securement with bordered polyurethane (Tegaderm™)
- Integrated securement dressing (SorbaView™)
- Integrated securement dressing with tissue adhesive (Secureport IV™)
Enrolled patients (n = 383) were seen in the emergency departments of two regional Australian hospitals and were admitted to inpatient care; patients were expected to require a peripheral IV for at least 24 hours. The primary outcome of interest was failure of the peripheral IV for any reason. Secondary outcomes included pain on removal, adverse events, and healthcare costs.
The data analysis showed that rates of IV failure and healthcare costs were lowest in the tissue adhesive group.
The editorial by Bettencourt and coauthors emphasized that a major challenge to use of this new IV securement method is implementation into clinical practice. Healthcare professionals need to be convinced to adopt the new methodology and must accept the need for education and training to ensure that the outcomes are optimal. Outcomes will need to be monitored to be certain that the success of IV securement with integrated securement dressing plus tissue adhesive is documented.
