Bariatric treatments for adult obesity - Institute of Health Economics

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TABLES AND FIGURESSection One: Social and System DemographicsTable S.1: Percentage of adult obesity by demographic, geographic, and comorbiditygroups in Alberta in 2007 ...................................................................................................... 15Table S.2: Activity limitation levels by BMI category in Alberta in 2007 ......................................... 16Table S.3: Classification of body weight and risk of health problems by BMIand waist circumference ......................................................................................................... 19Table S.4: Bariatric treatments for obese adults with different BMI, WC, andhealth risks/comorbidities ..................................................................................................... 26Table S.5: Number of bariatric surgical procedures provided to out-of-provincepatients in 2006 ...................................................................................................................... 34Table S.A.1: Search strategy ..................................................................................................................... 41Section Two: Technology Effects and EffectivenessTable T.1: Types of dietary therapy ........................................................................................................ 64Table T.2: Behavioural modification strategies ..................................................................................... 67Table T.3: History and mechanisms of antiobesity medications ....................................................... 68Table T.4: Bariatric surgery ...................................................................................................................... 70Table T.5: Overview of the included systematic reviews/HTAs ....................................................... 76Table T.6: Effects of dietary therapy/exercise on weight reduction ................................................. 80Table T.7: Effects of behavioural therapy on weight reduction ........................................................ 82Table T.8: HrQoL measures used in the 34 RCTs ............................................................................... 87Table T.9: European clinical practice guidelines, 2008 ........................................................................ 94Table T.10: Factors underlying weight regain after weight loss ......................................................... 96Table T.A.1: Search strategy .................................................................................................................. 101Table T.B.1: Excluded studies and reasons for exclusion ................................................................. 110Table T.C.1: Results of quality assessment for systematic reviews .................................................. 120Table T.D.1: Characteristics of the SRs/HTAs .................................................................................. 124Table T.D.2: Characteristics of the primary studies assessed in SRs/HTAs ................................. 129Table T.E.1: Safety profile ..................................................................................................................... 132Table T.F.1-1: Weight loss Dietary therapy/physical exercise ..................................................... 137Table T.F.1-2: Weight loss – Behavioural therapy ............................................................................. 138Table T.F.1-3: Weight loss – Pharmacotherapy ................................................................................. 139Bariatric treatments for adult obesity – March 2012xi
Table T.F.1-4: Weight loss – Surgery ................................................................................................... 140Table T.F.2: Quality of life (QoL) – All bariatric treatment strategies ............................................ 142Table T.F.3-1: Risk factors/Comorbidities – Dietary therapy/physical exercise .......................... 143Table T.F.3-2: Risk factors/Comorbidities – Behavioural therapy ................................................. 145Table T.F.3-3: Risk factors/comorbidities Pharmacotherapy ...................................................... 146Table T.F.3-4: Risk factors/Comorbidities – Surgery ....................................................................... 147Table T.F.3-6: Conclusions from the systematic reviews/HTAs .................................................... 149Table T.G.1: Patient characteristics ...................................................................................................... 151Table T.G.2: Effects of bariatric surgery on weight loss and HrQoL ............................................ 152Table T.G.3: Effects of bariatric surgery on risk factors/comorbidities ........................................ 153Table T.G.4: Effects of bariatric surgery on cancer, mortality, and adverse events ..................... 154Section Three: Economic EvaluationFigure E.1: Cost comparison by demographic, behaviour, and comorbidity categories .............. 173Figure E.2: Health utilization comparison by demographic, behaviour,and comorbidity categories ............................................................................................... 173Figure E.A.1: Progress through the selection of potentially relevant studies ................................ 185Table E.1: CCI code description for bariatric surgeries .................................................................... 162Table E.2: Number of retrieved articles by bariatric intervention ................................................... 163Table E.3: Distribution of surgical patients by city in 2006 .............................................................. 171Table E.4: Bariatric surgery costs per patient in 2006 ....................................................................... 171Table E.5: Mean costs and utilizations between 2004 and 2008 ...................................................... 171Table E.6: Economic burden of obesity in 2007 ................................................................................ 172Table E.A.1: Search strategy .................................................................................................................. 178Table E.A.2: Evidence table of reviewed economic studies ............................................................. 186Table E.B.1 Estimate of economic burden of obesity ...................................................................... 199Bariatric treatments for adult obesity – March 2012xii
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 12 and 13: Regulatory status .................
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
Page 64 and 65:
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:
Page 224 and 225:
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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