Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.D.1: Characteristics of the SRs/HTAs (cont’d)Poobalan et al., 2007 67To assess the long-term effectiveness ofweight loss on all cause mortality inoverweight/obese people.Databases searched: MEDLINE, EMBASE,CINAHLSearch date: 1966 to 2005Other sources: reference listInclusion criteria:Study: prospective studies (RCTs and cohort studies) with followup≥ two yearsPatients: adult (18 to 70 years), with BMI ≥ 25 kg/m 2 andCaucasian, Afro-American, Japanese American, or British Asianethnic originsExclusion criteria: general population study, animal study, studieswith less than 40% of follow-upAbbreviations: BMI = body mass index; HTA = health technology assessment; RCT = randomized controlled trial; NA = not available; QoL = quality of life; SR = systematic reviewBariatric treatments for adult obesity 128
Table T.D.2: Characteristics of the primary studies assessed in SRs/HTAsSRs/HTAs Patients InterventionDietary therapy/physical exerciseGalani &Schneider,2007 5630 RCTs (13for preventionstudies, 17 fortreatment)Shaw et al.,2006 5741 RCTsCurioni &Lourenco,2005 586 RCTs13 prevention studiesN = 3566 (range from 74–715)Mean age (yr): 49 (range from 43–62)% female: predominantEthnic origin: Australia, China, England,France, Finland, Italy, Netherlands, Norway,USBaseline weight (kg): mean 81Baseline BMI (kg/m 2 ): mean 28.9 (rangefrom 25–29.7)Comorbidity: hypertension, impaired glucosetolerance, diabetes17 treatment studiesN = 8013 (range from 24 to 2161)Mean age (year): 49 (range from 34 to 69)% female: predominantEthnic origin: Finland, Italy, Sweden, US, UKBaseline weight (kg): NABaseline BMI (kg/m 2 ): 34 (range from 30–37)Comorbidity: hypertension, T2DMN = 3476Age (yr): weighted mean 42.4 in 32 RCTs and range from 20–75 in the remaining nine RCTs% female: of 39 RCTs that reported gender distribution, men 100% in 17 RCTs, women 100% in15 RCTs, and 10 RCTs that included both men and womenEthnic origin: 24 RCTs conducted in the United States, four in the Netherlands, three each inAustralia and Canada, two in Israel, one each in Denmark, Germany, Norway, and the UnitedKingdomBaseline weight (kg): NABaseline BMI (kg/m 2 ): NAComorbidity: NAN = 514 (range from 40–127)Mean age (yr): range from 21–65% female: 100% women in three studies, 100% men in one study, both women and men in twostudiesEthnic origin: four RCTs conducted in US and two RCTs in FinandBaseline weight (kg): mean varied from 83.5–106Baseline BMI (kg/m 2 ): NAComorbidity: NAType: lifestyle intervention including dietary counseling andphysical exercise with or without behavioural modificationtechniquesDuration: 1 to 6 yearsDrop-out rate: range 3%–50% in prevention studies, and4%–38% in treatment studiesLength of follow-up: mean three yearsType: walking (21 trials), exercise bicycle (10 trials), jogging(eight trials), weights training (eight trials), commercial aerobic(five trials), treadmill (five trials), stair stepping (two trials),dancing (one trial), ball games (one trial), calisthenics (onetrial), rowing (one trial), aqua jogging (one trial)No trials evaluated swimming or water aerobics as weight lossinterventions.Duration: NADrop-off rate: < 15% in all studiesLength of follow-up: NAType: any type (not specified)Duration: range from 10–52 weeksDrop-off rate: mean 16.9% (range 9.4–24%)Length of follow-up: 12–24 monthsBariatric treatments for adult obesity 129
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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
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Description of the Included Systema
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Page 104 and 105: Evidence on Efficacy/EffectivenessW
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
Page 146 and 147: Table T.C.1: Results of quality ass
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Page 150 and 151: Table T.D.1: Characteristics of the
Page 154 and 155: Table T.D.2: Characteristics of the
Page 156 and 157: APPENDIX T.E: EVIDENCE TABLE ON SAF
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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
Page 172 and 173: Table T.F.3-5: Long-term effects of
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
Page 198 and 199: DiscussionThe objectives of the eco
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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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