Bariatric treatments for adult obesity - Institute of Health Economics

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Description of the Included Systematic Reviews/HTAsCharacteristics of the included studiesUsing the search strategy described in Appendix T.A, the literature search identified 1298 citations.For articles that appeared to be relevant, the full text was retrieved and reviewed. Sixteen systematicreviews/HTAs 2,15,20,38,56-67) met the inclusion criteria. Excluded systematic reviews/HTAs and thereasons for their exclusion are listed in Appendix T.B. Two reviews 61,63 were further excludedbecause of their poor methodological quality rating (see Appendix T.C). Fourteen systematicreviews/HTAs are included for analysis and synthesis (see Table T.5).Table T.5: Overview of the included systematic reviews/HTAsTreatment strategy(Number of SRs/HTAs)Dietary therapy/physical exercise (3)SRs/HTAsNumber ofincluded RCTs (Interventions)Galani & Schneider, 2007 5630 (lifestyle intervention)Shaw et al., 2006 57 41 (E, D)Curioni & Lourenco, 2005 58 6 (D, E)Behavioural therapy (1) Shaw et al., 2005 15 36 (BT, BT+D/E, CBT)Pharmacotherapy (3)Surgery (2)Multiple treatmentstrategies (5)Johansson et al., 2009 59Padwal et al., 2006 20Li et al., 2005 60Klarenbach et al., 2010 38Colquitt et al., 2009 6228 (orlistat, sibutramine, rimonabant)30 (orlistat, sibutramine, rimonabant)29 (orlistat)Tsai, 2009 64 10 (D, E, P)Maciejewski et al., 2005 65 34 (BT, P, S)64 (various surgical procedures)23 (various surgical procedures)Avenell et al., 2004 2 84 (D, E, BT, P, S)McTigue et al., 2003 66 33 (BT, P, S)Poobalan et al., 2007 67 8 (lifestyle intervention, S)Abbreviations: BT = behavioural therapy; CBT = cognitive behavioural therapy; D = diet; E = exercise; FU = follow-up; HTA =helath technology assessment; P = pharmacotherapy; RCTs = randomized controlled trials; S = surgery; SR = systematic reviewsOf the 14 systematic reviews/HTAs, three reviews focused on dietary therapy/physical exercise, 56-58one review 15 on behavioural therapy, three reviews 20,59,60 on weight loss medications, two reviews 38,62on bariatric surgery, and the other five reviews 2,64-67 assessed the safety and efficacy of multipletreatment strategies.As shown in Table T.5, for each intervention category (except behavioural therapy) a varyingnumber of RCTs was included in different systematic reviews/HTAs. However, a careful checkingof the reference lists revealed a great deal of overlap among the RCTs included in these reviews. Forreviews that focused on dietary therapy/physical exercise, 56-58 pharmacotherapy, 20,59,60 and surgery, 38,62the number of overlapping RCTs were 5, 37, and 18, respectively.For the primary studies assessed in the included systematic reviews/HTAs: details regarding the objectives, search strategies, and selection criteria are presented inAppendix T.D (Table T.D.1)Bariatric treatments for adult obesity 76
information regarding patient characteristics and interventions is presented in Appendix T.D(Table T.D.2)Methodological quality of the included systematic reviewsQuality assessment results for the 16 systematic reviews/HTAs are presented in Appendix T.C(Table T.C.1). Methodological quality was rated as “good” for six systematic reviews, 15,20,57-60“average” for eight systematic reviews, 38,55-62 and “poor” for two reviews. 61,63Most reviews searched databases beyond that of MEDLINE. Nine reviews used and reported astandardized method for data extraction; however, data extraction was conducted by twoindependent reviewers in only seven reviews. In more than half of the reviews, the methodologicalquality of the included studies was assessed by two independent reviewers. Conclusions from all ofthese reviews were supported by the results presented.Two reviews 61,63 were excluded from analysis and synthesis because of their poor quality ratingrelated to the robustness of the methodology used.Evidence on SafetyData about safety profile of each bariatric treatment strategy are presented in Appendix T.E (TableT.E.1).Dietary treatment/physical exerciseTwo systematic reviews 56,58 did not report any adverse events associated with dietary therapy orphysical exercise. The other review 57 reported that no data were identified on adverse events.Behavioural therapyThe only systematic review 15 in this category did not report any adverse events associated withbehavioural therapy.PharmacotherapyAs shown in Table T.E.1, one systematic review 59 specifically examined the rates of discontinuationof antiobesity medications due to their side effects. This review assessed 28 RCTs that included atotal of 13,457 patients having a mean BMI ranging from 33 to 38 kg/m 2 . Another systematicreview 20 also provided detailed information regarding adverse events (AEs) associated with the useof orlistat, sibutramine, or rimonabant.AEs for orlistatGastrointestinal (GI) adverse events are predominant in patients treated with orlistat. Fatty/oilystool, fecal urgency, and oily spotting are most common. Over 80% of patients experienced at leastone GI event. 20Most studies reported that GI side effects were mild and transient, and decreased as patientsadjusted to a low fat diet. However, high study attrition rates may reflect a differential dropout ofpatients who were unable to tolerate the medication, and may partly explain the improved toleranceof patients who remained in the study.Bariatric treatments for adult obesity 77
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Alberta STE ReportBariatric treatme
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Alberta STE ReportBariatric treatme
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EXECUTIVE SUMMARYSocial and System
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Three surgical procedures—adjusta
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Costs of Bariatric Surgery and Pote
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Regulatory status .................
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TABLES AND FIGURESSection One: Soci
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ABBREVIATIONSAll abbreviations that
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LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
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Bariatric physician: a licensed Doc
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High-density lipoprotein (HDL): a f
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Very-low-calorie diet (VLCD): a die
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Additional Internet searches were c
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This report addresses obesity in ad
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Many systemic factors have been ide
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Severe obesity is associated with d
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eport their height and under-report
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Also using self-reported data from
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An examination of overall obesity d
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Table S.2 presents the associationa
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• have multiple focal points and
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The main problem in any weight mana
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food, and a negative body image. As
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Page 62 and 63: Overview of adult obesityOver the p
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Page 68 and 69: Complianceand AdherenceDemand andut
Page 70 and 71: Aetna Clinical PolicyBulletinswww.a
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Page 74 and 75: REFERENCES1. 2006 Canadian clinical
Page 76 and 77: 34. Gostin LO. Fast and supersized:
Page 78 and 79: 69. Klarenbach S, Padwal R, Wiebe N
Page 80 and 81: 105. Hill JO, Thompson H, Wyatt H.
Page 82 and 83: 141. Ross R, Bradshaw AJ. The futur
Page 84 and 85: 172. Arkinson J, Ji H, Fallah S, Pe
Page 86 and 87: This section will address a set of
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Page 106 and 107: Table T.7: Effects of behavioural t
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Page 130 and 131: AMA Clinical PracticeGuidelineswww.
Page 132 and 133: critical appraisal of the included
Page 134 and 135: APPENDIX T.B: EXCLUDED STUDIESTable
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Page 140 and 141: Quality subsection 5a:Study quality
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Table T.D.1: Characteristics of the
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APPENDIX T.E: EVIDENCE TABLE ON SAF
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Serious surgical complicationsSurgi
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LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
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Table T.F.1-2: Weight loss - Behavi
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Table T.F.1-4: Weight loss - Surger
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Table T.F.2: Quality of life (QoL)
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Curioni & Lourenco 2005 58Cholester
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Table T.F.3-3: Risk factors/comorbi
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Table T.F.3-5: Long-term effects of
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Maciejewski et al., 2005 65Avenell
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Table T.G.2: Effects of bariatric s
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Table T.G.4: Effects of bariatric s
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18. Cerulli J, Lomaestro BM, Malone
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50. Health Canada Drug Product Data
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SECTION THREE: ECONOMIC EVALUATIONC
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Definition of bariatric surgical pa
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etween surgical interventions, the
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concluded that adding orlistat to L
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Weight management program (WMP) ver
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groups. Compared with standard care
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Results from Analysis of Provincial
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DiscussionThe objectives of the eco
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surgical suites, and so on. The bud
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APPENDIX E.A: LITERATURE SEARCH SUM
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CRD Databases(DARE, HTA & NHS EED)h
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Web of ScienceISI Interface License
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NEOS Librarywww.library.ualberta.ca
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Table E.A.2: Evidence table of revi
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ResultHealth outcomesCostsMarginal
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CostsMarginal analysisThe cost anal
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Time Horizon/discount rateCurrency/
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Objectivestudy perspective: society
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S4Economic burden of obesityMean co
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15. Lacey LA, Wolf A, O'shea D, Ern
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Author Contribution StatementsPaula
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