Bariatric treatments for adult obesity - Institute of Health Economics

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LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGVBGWCWLlaparoscopic sleeve gastrectomymetremeta-analysismean differencenot availablenot statistically significantodds ratioquality of liferandomized controlled trialrisk differencerelative riskRoux-en-Y gastric bypasssystolic blood pressuretriglyceridevertical banded gastroplastywaist circumferenceweight lossBariatric treatments for adult obesity 136
Table T.F.1-1: Weight loss Dietary therapy/physical exerciseSRs/HTAsGalani & Schneider, 2007 56Prevention studies:N of trials: four, high quality studiesN of patients: 1168; mean BMI 27kg/m 2Treatment studies:N of trials: five, high qualityN of pts: 3032; mean BMI 33 kg/m 2Shaw et al., 2006 57N of trials: 41N of patients: 3476, overweight(BMI >25 kg/m 2 ) or obese (BMI ≥30kg/m 2 )Curioni & Lourenco, 2005 58N of trials: sixN of patients: 514; BMI unknownWeight loss (WL)Lifestyle interventions versus standard care (not defined)Weight (kg): MD 3.1(P = 0.0001) (prevention studies); MD 5.1 (P < 0.0001) (treatment studies)BMI (kg/m 2 ): NA in prevention studies; MD 1.8 (P = 0.001) (treatment studies)Exercise (E) versus no treatment (12 trials)Weight (kg): exercise increased WL compared to no treatment. E: 0.5 to 4.0 versus no treatment: 0.1 to +0.7BMI (kg/m 2 ): exercise reduced BMI more than no treatment. E: 0.3 to 0.7 versus no treatment: +0.3 to +0.4E versus diet (D) (10 trials)Weight (kg): Diet resulted in greater WL as compared to exercise. E: +0.5 to +4.0 versus D: 2.8 to 13.6BMI (kg/m 2 ): Diet resulted in greater reduction in BMI as compared to exercise. E: 0.3 to 0.8 versus D: 0.3 to 3.3E+D versus D (17 trials)Weight (kg): E+D resulted in greater (1.1 kg more) WL as compared to D alone. E+D: 3.4 to 17.7 versus D: 2.3 to 16.7BMI (kg/m 2 ): E+D resulted in greater (0.4 kg more) reduction in BMI as compared to D alone. E+D: 0.6 to 4.0 versus D: 0.3 to 4.0High-intensity E versus low-intensity E (eight trials)Weight (kg): increasing the intensity of exercise increased the weight loss if participants were not on a diet; high-intensity exercisers lost 1.5kg more than low-intensity exercisers; high-intensity E: 1.3 to 8.9 versus low-intensity E: 6.3 to +0.1BMI (kg/m 2 ): insufficient data for analysisHigh-intensity E versus low-intensity E with D (8 trials)Weight (kg): increasing the intensity did not increase the weight loss if participants were on a dietBMI (kg/m 2 ): same as aboveWeight loss: individuals in the diet plus exercise group had a mean WL after intervention approximately 20% greater than individuals inthe diet group: –13.0±10.4 kg versus –9.9±9.6 (P = 0.063)Weight maintenance: individuals in the diet plus exercise group had a mean WL after 1 year approximately 20% greater than individualsin diet group: –0.67±8.3 kg versus –4.5±11.3 (P = 0.058)% WL from baseline: immediately after intervention: –13±5.5% versus –10±3.6%; after 1 year: –6.8±4.1% versus –4.6±2.5%; weightregain after 1 year: –50±8.2% versus 50±5.9%Bariatric treatments for adult obesity 137
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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
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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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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
Page 148 and 149: APPENDIX T.D: CHARACTERISTICS OF SY
Page 150 and 151: Table T.D.1: Characteristics of the
Page 156 and 157: APPENDIX T.E: EVIDENCE TABLE ON SAF
Page 158 and 159: Serious surgical complicationsSurgi
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
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Page 192 and 193: Weight management program (WMP) ver
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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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Page 208 and 209: 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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