Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.D.2: Characteristics of the primary studies assessed in SRs/HTAs (cont’d)Behavioural therapy (BT)Shaw et al.,2005 1536 RCTsPharmacotherapyN = 3495Mean age (yr): weighted mean 43.1 in 18 trials that reported mean age; rangefrom 16–75 in the remaining 18 trials that reported only age range% females: 100% men (2 trials), 100% women (14 trials), 25% men and 75%women (across 20 trials)Ethnic origin: 29 trials conducted in US, one each in Canada, Columbia,Netherlands, Spain, Sweden, Switzerland, the United KingdomBaseline weight (kg): NAMean baseline BMI (kg/m 2 ): > 25 in most studiesComorbidity: diabetes (two trials), impaired glucose tolerance (two trials), mildhypertension (one trial), binge eating disorder (two trials)Type: BT, BT+D/E, CBT, cognitive therapy, hypnotherapy, relaxationDuration: median 12 weeks (range from 4 weeks to 12 months)Intensity: range from daily to monthlyDrop-out rate: ≤ 15% in all studiesLength of follow-up: range 3 to 36 monthsJohansson etal., 2009 5928 RCTsPadwal et al.,2004 2030 RCTs(16 on orlistat,10 onsibutramine, 4on rimonabant)N = 13,457 (orlistat n=7038, sibutramine n=1475, rimonabant n=4944)Mean age (yr): range from 41–59% female: greater proportion of women than of men in most studiesEthnic origin: predominantly whiteBaseline weight (kg): NAMean baseline BMI (kg/m 2 ): range from 33–38Comorbidity: hypertension, hypercholesterolemia, T2DM, dyslipidemia, coronaryartery disease, risk factors of CVDType: orlistat, sibutramine, rimonabantDosage: orlistat 360 mg/day, sibutramine (10–15 mg/day), rimonabant (20mg/day)Co-intervention: diet with or without exercise in all studiesDrop-out rate: 30% for orlistat, 34% for sibutramine, 39% for rimonabantLength of follow-up: 12 to 18 monthsOrlistat Sibutramine Rimonabant Type Orlistat Sibutramine RimonabantN = 19,889 10,631 2623 6635 Dosage 120 mg t.i.d. 10–20 mg/day;15 mg/day mostcommonly usedMean age (yr) 47 45 48 Co-% females 66% 73% 73%interventionEthnic origin 89% Caucasian 95% Caucasian 87% CaucasianMean baselineweight (kg)Mean baselineBMI (kg/m 2 )Comorbidity104 97 10236.3 35.1 36.5dyslipidemia, DM,HTN, impairedglucose toleranceHTN, DMdyslipidemia, DM,HTNDrop-out rate(range)Length offollow-up(yrs)standardized, lowfat, hypocaloricdiet;encouragementto exercisedietarymodification withor without adviceto exercise20 mg/daydietarymodificationwith or withoutadvice toexercise30% (0–66%) 40% (11%–51%) 40% (32–49%)1–4 1–1.5 1–2Bariatric treatments for adult obesity 130
Table T.D.2: Characteristics of the primary studies assessed in SRs/HTAs (cont’d)Li et al., 2005 6029 RCTs onorlistatSurgeryKlarenbach etal., 2010 3864 RCTsColquitt et al.,2009 6223 RCTs, 3prospectivecohort studiesN = NAMean age (yr): 48% female: 73%Ethnic origin: NABaseline weight (kg): NAMean baseline BMI (kg/m 2 ): 36.7Comorbidity: NASurgery vs another surgeryor standard care (31 trials)Open versus laparoscopic(eight trials)N Median 59, range 16–310 median 60 (range 30–155)Type: orlistatDosage: NACo-intervention: diet in all experimental arms in all studies; educational,behavioural, and psycho-social co-interventions in 39% of the studies, andexercise in 18% of the studiesDrop-out rate: NALength of follow-up: six to 12 monthsSurgery vs another surgery orstandard care (31 trials)Mean age (yr) range 30–48 range 35–48 Type AGB, RYGB, sleeve% female range 44%–97% range 68%–94%gastrectomy, JB, loop gastricbypass, mini-gastric bypass,BPD, HG, VBGEthnic origin NA NA Co-Baseline NANAinterventionweight (kg)Meanbaseline BMI(kg/m 2 )Comorbidityrange 34–59 range 42–51 Length offollow-up(month)DM, HTN(reported in two trials)N: range 204047Mean age (yr): range 3249% females: majorityEthnic origin: NABaseline weight (kg): NABaseline BMI (kg/m 2 ): range 37–52Comorbidity: NADM, dyslipidemia, HTN(reported in two trials)no medical treatmentOpen versus laparoscopic(eight trials)RYGB, VBG, AGBno medical treatmentmedian 24 (range 6–60) median 12 (range 10–39)Type: gastric bypass, AGB, sleeve gastrectomy, VBG, biliopancreaticdiversionCo-intervention: NALength of follow-up: 12–84 months for RCTs, 10 years for the SOS studyAbbreviations: AGB = adjustable gastric banding; BMI = body mass index; BPD = biliopancreatic diversion; BT = behavioural therapy; CBT = cognitive behavioural therapy; D = diet;DM = diabetes mellitus; E = exercise; HG = horizontal gastroplasty; HTA = health technology assessment; HTN = hypertension; JB = jejunoileal bypass; kg = kilogram; m = meter; mg= milligram; N = total number; NA = not available; RCT = randomized controlled trial; RYGB = Roux-en-Y gastric bypass; SR = systematic review; T2DM = type 2 diabetes; t.i.d =three times a day; UK = United Kingdom; US = the United States; VBG = vertical banded gastroplastyBariatric treatments for adult obesity 131
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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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AEs for sibutramineAs compared to a
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
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Page 152 and 153: Table T.D.1: Characteristics of the
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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
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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
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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Page 202 and 203: 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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