Bariatric treatments for adult obesity - Institute of Health Economics

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Regulatory status ....................................................................................................................................... 73Methodology ..................................................................................................................................................... 75Literature search ........................................................................................................................................ 75Selection of literature ................................................................................................................................ 75Quality assessment .................................................................................................................................... 75Data extraction .......................................................................................................................................... 75Data analysis and synthesis ...................................................................................................................... 75Description of the Included Systematic Reviews/HTAs ........................................................................... 76Characteristics of the included studies ................................................................................................... 76Methodological quality of the included systematic reviews ................................................................ 77Evidence on Safety .......................................................................................................................................... 77Dietary treatment/physical exercise ....................................................................................................... 77Behavioural therapy .................................................................................................................................. 77Pharmacotherapy ...................................................................................................................................... 77Bariatric surgery ......................................................................................................................................... 78Evidence on Efficacy/Effectiveness............................................................................................................. 80Weight loss ................................................................................................................................................. 80Risk factors/comorbidities ...................................................................................................................... 85Health-related quality of life (HrQoL)................................................................................................... 86Long-term outcomes ................................................................................................................................ 88Findings from other SRs that assessed multiple treatment strategies ............................................... 92Clinical Practice Guidelines/Position Statements ....................................................................................... 94Discussion ......................................................................................................................................................... 94Assessment limitations ............................................................................................................................. 94Methodological issues of the primary studies ....................................................................................... 95Impacts of patient characteristics on outcomes ................................................................................... 95Gaps in evidence and future research .................................................................................................... 97Implementation consideration ................................................................................................................ 98Conclusion ........................................................................................................................................................ 99Appendix T.A: Methodology ....................................................................................................................... 101Appendix T.B: Excluded Studies ................................................................................................................. 110Appendix T.C: Methodological Quality Assessment ................................................................................ 113Bariatric treatments for adult obesity – March 2012ix
Appendix T.D: Characteristics of Systematic Reviews/HTAs ............................................................... 124Appendix T.E: Evidence Table on Safety .................................................................................................. 132Appendix T.F: Evidence Tables on Efficacy/Effectiveness ................................................................... 135Appendix G: Summary of Swedish Obesity Subject (SOS) Study ......................................................... 151References ....................................................................................................................................................... 155Section Three: Economic Evaluation ................................................................................... 160Charles Yan, PhD, Anderson Chuck, MPH, PhDEconomic Analysis (E).................................................................................................................................. 160Objectives and Policy Questions ................................................................................................................. 160Methods .................................................................................................................................................... 160Review of economic studies .................................................................................................................. 160Secondary analysis of Provincial Health Utilization databases ......................................................... 161Secondary analysis of Provincial Health Utilization databases and CCHS data ............................ 162Literature review findings ...................................................................................................................... 163Results from Analysis of Provincial Health Utilization Data .................................................................. 170Costs of bariatric surgery ....................................................................................................................... 170Impact of bariatric surgery on healthcare costs and utilizations ...................................................... 171Results from Analysis of Provincial Health Utilization and CCHS data ............................................... 172Discussion ....................................................................................................................................................... 174Conclusion ...................................................................................................................................................... 176Caveats ............................................................................................................................................................. 177Appendix E.A: Literature Search Summary: Bariatric Services – Effectiveness .................................. 178Appendix E.B ................................................................................................................................................. 199References ....................................................................................................................................................... 201Bariatric treatments for adult obesity – March 2012x
Page 1 and 2: Alberta STE ReportBariatric treatme
Page 3 and 4: Alberta STE ReportBariatric treatme
Page 5 and 6: EXECUTIVE SUMMARYSocial and System
Page 7 and 8: Three surgical procedures—adjusta
Page 9: Costs of Bariatric Surgery and Pote
Page 14 and 15: TABLES AND FIGURESSection One: Soci
Page 16 and 17: ABBREVIATIONSAll abbreviations that
Page 18 and 19: LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
Page 20 and 21: Bariatric physician: a licensed Doc
Page 22 and 23: High-density lipoprotein (HDL): a f
Page 24 and 25: Very-low-calorie diet (VLCD): a die
Page 26 and 27: Additional Internet searches were c
Page 28 and 29: This report addresses obesity in ad
Page 30 and 31: Many systemic factors have been ide
Page 32 and 33: Severe obesity is associated with d
Page 34 and 35: eport their height and under-report
Page 36 and 37: Also using self-reported data from
Page 38 and 39: An examination of overall obesity d
Page 40 and 41: Table S.2 presents the associationa
Page 42 and 43: • have multiple focal points and
Page 45 and 46: The main problem in any weight mana
Page 47: food, and a negative body image. As
Page 50 and 51: directly causes death. 61 To the ex
Page 52 and 53: The addition of a selected pharmaco
Page 54 and 55: lack of formal training in nutritio
Page 56 and 57: slightly more likely to have prescr
Page 58 and 59: selection criteria, have facilities
Page 60 and 61: Barriers to using appropriate baria
Page 62 and 63:
Overview of adult obesityOver the p
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the need for regular physical activ
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phenylpropanolamine/25. Sibutramine
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Complianceand AdherenceDemand andut
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Aetna Clinical PolicyBulletinswww.a
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Overweight 123,821 172,971 157,623
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REFERENCES1. 2006 Canadian clinical
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34. Gostin LO. Fast and supersized:
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69. Klarenbach S, Padwal R, Wiebe N
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105. Hill JO, Thompson H, Wyatt H.
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141. Ross R, Bradshaw AJ. The futur
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172. Arkinson J, Ji H, Fallah S, Pe
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This section will address a set of
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dietary therapy is to reduce total
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Additional benefits of exercise ove
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medications that inhibit intestinal
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Rimonabant may be considered for pa
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Long-term complications are specifi
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Devices used for bariatric surgeryH
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Description of the Included Systema
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AEs for sibutramineAs compared to a
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Evidence on Efficacy/EffectivenessW
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Table T.7: Effects of behavioural t
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SurgeryDescription of the included
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follow-up time was 3 years. Results
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group as compared to the VBG group.
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The authors identified many methodo
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The investigators pointed out that
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approximately 3 to 5 kilograms. For
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for studies with a mean age of part
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Examining whether use of any of the
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Evidence from placebo-controlled cl
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colorectal or gastroesophageal or f
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Web of ScienceISI Interface License
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AMA Clinical PracticeGuidelineswww.
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critical appraisal of the included
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APPENDIX T.B: EXCLUDED STUDIESTable
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Padwal R, Li SK, Lau DC. Long-term
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Quality subsection 1: At least MEDL
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Quality subsection 5a:Study quality
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Partially reported: The study types
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Table T.C.1: Results of quality ass
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Table T.C.1: Results of quality ass
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APPENDIX T.D: CHARACTERISTICS OF SY
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Table T.D.1: Characteristics of the
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Page 154 and 155:
Page 156 and 157:
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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Page 222 and 223:
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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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