Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.D.1: Characteristics of the SRs/HTAs (cont’d)Li et al., 2005 60To assess the efficacy and safety of weightloss medications approved by the US Foodand Drug Administration, and othermedications that have been used for weightloss.SurgeryKlarenbach et al., 2010 38To assess the evidence on clinicaleffectiveness and safety, and economicimplications of using different bariatricsurgery methods in adult patients with severeobesity.Colquitt et al., 2009 62To assess the effects of bariatric surgery forobesity on weight, comorbidity, and quality oflife.Databases searched: MEDLINE, CochraneControlled Clinical Trials Register DatabasesSearch date: up to 2002Other sources: reference listDatabases searched: MEDLINE (1950 to 3February 2009), EMBASE (1980 to 3February 2009), Cochrane Central Register ofControlled Trials (3 February 2009)Search date: see aboveOther sources: hand searching and referencelistDatabases searched:The Cochrane Library (Issue 3/2008);MEDLINE (until 29/7/2008); EMBASE(until 29/7/2008); PsychInfo (until29/7/2008); CINAHL (until 16/7/2008);Science and Social Sciences Citation Index(until 29/7/2008); British Nursing Index (until6/8/2008).Search date: see aboveOther sources: contact experts, reference listInclusion criteria:Study: RCTs and quasi-RCTsPatients: adults with a BMI ≥ 27 kg/m 2Intervention: sibutramine, orlistat, phentermine, diethypropion,fluoxine, bupropion, sertraline, topiramate, and zonisamideComparator: placebo or another drugExclusion criteria: NAInclusion criteria:Study: parallel quasi-RCTs or RCTsPatients: severely obese adults (16 years or older), with an acceptedindication for bariatric surgery: BMI of 40 kg/m 2 or more (or BMIof 35 kg/m 2 or more with at least one obesity-related comorbidity)Intervention: at least one bariatric surgical interventionComparators: different bariatric surgical interventions, standardcare (diet and exercise), pharmacologic intervention, open andlaparoscopic approaches, variant of the same surgical interventionExclusion criteria: intervention: non-surgical bariatric proceduressuch as intra-gastric balloonsInclusion criteria:Study: RCTs comparing surgical interventions with other surgicalinterventions; RCTs, controlled trials, and prospective cohortstudies comparing surgery with non-surgical treatment (medicaltreatment or no treatment); follow-up ≥ one yearPatients: adults with a BMI ≥ 30, young people who fulfill thedefinition of obesity for their age, sex, and heightIntervention: different surgical proceduresComparator: usual care (no treatment or medical treatment),different surgical procedures, open, and laparoscopic approachesExclusion criteria: comparison of variations of surgical techniquesrather than different procedures; procedures not in current use:jejunoileal bypass procedure, horizontal gastroplasty, verticalgastroplasty, banded gastroplasty that is not adjustableBariatric treatments for adult obesity 126
Table T.D.1: Characteristics of the SRs/HTAs (cont’d)Multiple strategiesTsai, 2009 64This review examines the results of RCTs inwhich behavioural weight loss interventions,used alone or with pharmacotherapy, wereprovided in primary care settings.Maciejewski et al., 2005 65To estimate the effect of weight lossinterventions on health-related quality of lifein RCTs; to conduct a meta-analysis of weightloss treatment on depressive symptoms; and,to examine methodological and presentationissues that compromise study validity.Avenell et al., 2004 2To review systematically obesity treatments inadults, to identify therapies that impact byachieving weight reduction, risk factormodification, or improved clinical outcomes.McTigue et al., 2003 66To examine the evidence of the benefits andharms of screening and of earlier treatment inreducing morbidity and mortality fromoverweight and obesity.Databases searched: MEDLINE, EMBASE,Cochrane systemtic review, CINAHLSearch date: 1950 to January 2009Other sources: reference listDatabases searched: MEDLINE,HealthStar, PsychINFOSearch date: 1966 to 2003Other sources: NADatabases searched: 13 databases includingMEDLINE, EMBASE, etcSearch date: MEDLINE (1966 to May 2001),EMBASE (1980 to Week 19 2001)Other source: hand search of specificjournalsDatabases searched: MEDLINESearch date: 1994 to 2001Other sources: NAInclusion criteria:Study: RCTs conducted in the United StatesPatients: adultsIntervention: counseling conducted by primary care providers oranother provider working in the primary care officeExclusion criteria: intervention trials were not primary-care-based;non-US study; pediatric trials; non-intervention trials (e.g., surveys)Inclusion criteria:Study: RCTs published between 1996 and July 2003Patients: adults (≥ 18 years)Intervention: behavioural therapy, pharmacotherapy, and surgeryOutcome measures: QoL, depressive symptomsExclusion criteria: non-English language publication, studies thatfocused on pregnancy-related obesity or gestational diabetesInclusion criteria:Study: RCTs with follow-up ≥ one year; full text articlesPatients: adults (≥ 18 years) with BMI ≥ 28 kg/m 2Intervention: diets, exercise, behavioural therapy, medication, andsurgeryOutcomes: weight loss as a main outcome; no comparison fordietary advice alone with exercise alone for weight managementExclusion criteria: abstractsInclusion criteria:Study: RCTs with at least one year follow-up (six months forpharmacological studies) reporting weight reduction or healthoutcomes for treatment and harms questionsExclusion criteria: NABariatric treatments for adult obesity 127
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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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Devices used for bariatric surgeryH
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.
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Page 122 and 123: Examining whether use of any of the
Page 124 and 125: Evidence from placebo-controlled cl
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Page 128 and 129: Web of ScienceISI Interface License
Page 130 and 131: AMA Clinical PracticeGuidelineswww.
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Page 134 and 135: APPENDIX T.B: EXCLUDED STUDIESTable
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Page 138 and 139: Quality subsection 1: At least MEDL
Page 140 and 141: Quality subsection 5a:Study quality
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Page 166 and 167: Table T.F.2: Quality of life (QoL)
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Page 174 and 175: Maciejewski et al., 2005 65Avenell
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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
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Page 196 and 197: Results from Analysis of Provincial
Page 198 and 199: 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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