Bariatric treatments for adult obesity - Institute of Health Economics

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APPENDIX T.D: CHARACTERISTICS OF SYSTEMATIC REVIEWS/HTASTable T.D.1: Characteristics of the SRs/HTAsStudy objective Search Selection criteriaDietary therapy/physical exerciseGalani & Schneider, 2007 56To assess the effectiveness, mid- to longterm(one to six years), of lifestyleinterventions in the prevention andtreatment of obesity.Shaw et al., 2006 57To assess exercise as a means of achievingweight loss in people with overweight orobesity, using randomized controlled clinicaltrials.Curioni & Lourenco, 2005 58To carry out an SR with meta-analysis ofRCTs, assessing the effectiveness of exercisecombined with dietary interventions in initialweight loss and its long-term maintenanceamong overweight and obese people.Databases searched: MEDLINE, EMBASE,CinhalSearch date: 1995 to 2005 (due toadvancements in research toward conductinghigh quality studies and better reporting).Other sources: reference list and booksDatabases searched: Cochrane library,MEDLINE, EMBASE, Sport DiscussSearch date: up to 2005Other sources: reference list of reviewarticles and all included studiesDatabases searched: Cochrane library,MEDLINE, Lilacs (Latin American andCaribbean Literature in Health Science)Search date: up to 2003Other source: reference listInclusion criteria:Study: RCTs with a follow-up ≥ one yearPatients: adults (≥ 18 years), overweight and obeseExclusion criteria: NAInclusion criteria:Study: RCTs with study duration ≥ three monthsPatients: adults (≥ 18 years) with baseline BMI > 25 kg/m 2Intervention: exercise (defined as any form of physical activityperformed on a repeated basis for any defined period of time) ascompared to placebo or another non-pharmacological weight lossinterventionsExclusion criteria: trials with a drop-out rate > 15%Inclusion criteria:Study: RCTs with follow-up ≥ one yearPatients: adults (≥ 18 years), BMI ≥ 25 kg/m 2Exclusion criteria: pregnant women or children or on the use of any medication studies of behavioural therapy as the only interventionBariatric treatments for adult obesity 124
Table T.D.1: Characteristics of the SRs/HTAs (cont’d)Behavioural therapyShaw et al., 2005 15To assess the effects of psychologicalinterventions for overweight or obesity as ameans of achieving sustained weight loss.PharmacotherapyJohansson et al., 2009 59To assess the risk ratio, risk difference, andnumber needed to harm of drop-out due toadverse events for orlistat, sibutramine, orrimonabant as compared to placebo.Padwal et al., 2004 20To assess/compare the effects and safety ofapproved anti-obesity medications in clinicaltrials of at least one year duration.Databases searched: MEDLINE, EMBASE,PsychInfo, PsychLitSearch date: up to June 2003Other sources: reference listDatabases searched: MEDLINE, EMBASE,Cochrane controlled trials registrationSearch date: 1990 to May 2008Other sources: reference listDatabases searched: MEDLINE (untilDecember 2006), EMBASE (until week 51,2006), The Cochrane Library (Issue 4, 2006)Search date: see aboveOther sources: reference list, contact of drugmanufacturers, and clinical expertsInclusion criteria:Study: RCTs with follow-up ≥ three monthsPatients: adults (18 years or older) with a baseline BMI > 25 kg/m 2Intervention: psychological intervention versus a comparisoninterventionExclusion criteria: trials with a drop-out rate > 15% studies that combined a pharmacological intervention with apsychological interventionInclusion criteria:Study: RCTs with a study duration of 12 to 24 monthsPatients: adultsIntervention: licensed drugsExclusion criteria:maintenance study; studies that used non-standardized clinical dosesof orlistat (180 mg), sibutramine (> 15 mg), or rimonabant (5 mg)Inclusion criteria:Study: RCTs with a follow-up (from the point of randomization) ≥one year, includes intention to treat analysisPatients: ≥ 18 years, BMI ≥ 30 kg/m 2 , or BMI ≥ 27 kg/m 2 withone or more obesity-related comorbiditiesIntervention: sibutramine, orlistat, phentermine, mazindol,diethylpropion, benzphetamine, phendimetrazine, rimonabantComparator: placeboExclusion criteria: NABariatric treatments for adult obesity 125
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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.
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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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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 110 and 111: follow-up time was 3 years. Results
Page 112 and 113: group as compared to the VBG group.
Page 114 and 115: The authors identified many methodo
Page 116 and 117: The investigators pointed out that
Page 118 and 119: approximately 3 to 5 kilograms. For
Page 120 and 121: for studies with a mean age of part
Page 122 and 123: Examining whether use of any of the
Page 124 and 125: Evidence from placebo-controlled cl
Page 126 and 127: colorectal or gastroesophageal or f
Page 128 and 129: Web of ScienceISI Interface License
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
Page 136 and 137: Padwal R, Li SK, Lau DC. Long-term
Page 138 and 139: Quality subsection 1: At least MEDL
Page 140 and 141: Quality subsection 5a:Study quality
Page 142 and 143: Partially reported: The study types
Page 144 and 145: Table T.C.1: Results of quality ass
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Page 158 and 159: Serious surgical complicationsSurgi
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Page 162 and 163: Table T.F.1-2: Weight loss - Behavi
Page 164 and 165: Table T.F.1-4: Weight loss - Surger
Page 166 and 167: Table T.F.2: Quality of life (QoL)
Page 168 and 169: Curioni & Lourenco 2005 58Cholester
Page 170 and 171: Table T.F.3-3: Risk factors/comorbi
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Page 174 and 175: Maciejewski et al., 2005 65Avenell
Page 176 and 177: Table T.G.2: Effects of bariatric s
Page 178 and 179: Table T.G.4: Effects of bariatric s
Page 180 and 181: 18. Cerulli J, Lomaestro BM, Malone
Page 182 and 183: 50. Health Canada Drug Product Data
Page 184 and 185: SECTION THREE: ECONOMIC EVALUATIONC
Page 186 and 187: Definition of bariatric surgical pa
Page 188 and 189: etween surgical interventions, the
Page 190 and 191: concluded that adding orlistat to L
Page 192 and 193: Weight management program (WMP) ver
Page 194 and 195: groups. Compared with standard care
Page 196 and 197: 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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