Bariatric treatments for adult obesity - Institute of Health Economics

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critical appraisal of the included studies qualitative or quantitative data synthesisSystematic reviews of observational studies will also be included for long-term (defined as ≥ 5 years)clinical outcomes if they are not available in RCTs.Population: adults (18 years or older) who are overweight (BMI between 25 and 29.9 kg/m 2 ) orobese (BMI ≥ 30 kg/m 2 ).Intervention: dietary treatment, physical exercise, behavioural therapy, pharmacotherapy, andbariatric surgery, alone or in combination.Comparator: comparisons of multiple (≥ 3) treatment options within the same intervention strategy(for example, different medications); comparisons of different intervention strategies (for example,dietary treatment versus exercise); and comparisons of combination of intervention strategies to oneof the intervention strategies within the combination (for example, exercise and diet versus dietalone).Outcome of interest: included at least one of the following outcome measures: 1anthropometric outcomes: body weight, BMI, waist circumferencebiomedical or physical outcomes: fasting glucose, total cholesterol, low-densitylipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, ratioof total cholesterol to HDL cholesterol, and systolic and diastolic blood pressureclinical outcomes: comorbidities, mortality, and quality of life Psychosocial outcomes: depression, mood disorders and eating disorders, suicidalbehaviour, and suicide.Publication: Full text articles published in English.Exclusion criteriaStudies are excluded if they meet any of the following criteria.Study design: Systematic reviews/HTAs of a single treatment, or comparison between twotreatment options within the same treatment strategy or primary studies.Population: Systematic reviews/HTAs that targeted a specific population such pediatric patients(
Clinical practice guidelines/care pathways: for clinical indications/contraindications for thevarious treatment strategies.Data extractionOne reviewer (BG) extracted data from the included systematic reviews/HTAs according to apredetermined data extraction form.search strategy (databases searched and search dates)study selection criteria (inclusion and exclusion criteria)characteristics of the included studies (patients characteristics: number, age, gender,ethnic origin, baseline weight, BMI, and comorbidity; intervention characteristics: type, dose,duration, drop-out rate, follow-up)methodological quality of the included studiesresultsevidence of safetyo Any adverse events associated with the treatment strategiesevidence of efficacyo anthropometric outcomes: body weight, BMI, waist circumferenceo biomedical/physical outcomes: fasting glucose, total cholesterol, low-densitylipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides,ratio of total cholesterol to HDL cholesterol, and systolic and diastolic blood pressureo clinical outcomes: comorbidities, mortality, and quality of lifeo psychosocial outcomes: depression, mood disorders and eating disorders, suicidalbehaviour, and suicideMethodological quality assessmentTwo reviewers (BG and MO) independently assessed methodological quality of the included studiesusing an IHE quality assessment tool for systematic reviews. The quality rating results from the tworeviewers were compared and discrepancies between the reviewers’ results were resolved bydiscussion.Data analysis and synthesisData extracted from the included systematic reviews/HTAs were described and integrated using anarrative approach.External reviewMembers of the provincial expert advisory committee assembled for this project reviewed this draftreport.Bariatric treatments for adult obesity 109
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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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directly causes death. 61 To the ex
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The addition of a selected pharmaco
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lack of formal training in nutritio
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slightly more likely to have prescr
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selection criteria, have facilities
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Barriers to using appropriate baria
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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.
Page 82 and 83: 141. Ross R, Bradshaw AJ. The futur
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Page 90 and 91: Additional benefits of exercise ove
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Page 100 and 101: Description of the Included Systema
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Page 106 and 107: Table T.7: Effects of behavioural t
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Page 128 and 129: Web of ScienceISI Interface License
Page 130 and 131: AMA Clinical PracticeGuidelineswww.
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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Page 150 and 151: Table T.D.1: Characteristics of the
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Page 174 and 175: Maciejewski et al., 2005 65Avenell
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Page 178 and 179: Table T.G.4: Effects of bariatric s
Page 180 and 181: 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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