Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.F.1-2: Weight loss – Behavioural therapy 15Intervention/Comparator(No. of trials)*Weight loss (WL)BT versus no treatment (10)High-intensity versuslow-intensity BT (17)BT + D/E versus D/Ealone (8)Cognitive therapy versus BT (3)Cognitive therapy versusplacebo (1)CBT + D/E versus D/Ealone (2)Hypnotherapy versusplacebo (1)Relaxation versusplacebo (1)CBT versus no treatment (1)Qualitative synthesis of four trials: BT: 0.6 kg to 5.5 kg versus no treatment: 2.8 kg to +1.8 kgMA of the remaining six studies: study duration < 12 months (5 studies): BT patients lost 2.5 kg (95% CI 1.7 to 3.3) more than no-treatmentpatients (P < 0.01); study duration > 12 months (two trials): BT patients lost 2.0 kg (95% CI 2.7 to 1.3) more than no-treatment patients (P 12 months (one trial, follow-up 36 months): high-intensity BT: 1.6 kg versus low-intensity BT: 1.4 kg (P = 0.45)Qualitative synthesis of two trials: BT + D/E: 10 kg versus D/E: +0.5 kgMA of the remaining six trials: five studies favored the intervention groups and one study favored the control groupsIn all three trials, BT groups lost more weight than cognitive therapy groupAt 6 months: cognitive therapy: +1.35 kg versus + placebo: 0.6 kgMA of two trials: both groups lost weight overall; 4.9 kg (95% CI: 7.3 to 2.4) more WL in CBT + D/E than in D/E aloneAt 5 months: hypnotherapy: 2.1 kg versus placebo: 0.2 kgAt 6 months: relaxation: 7.9 kg versus placebo: 0.2 kgAt 6 months: CBT: 0.6 kg versus no treatment: +4.1 kgCBT versus BT (1) At 6 months: CBT: 7.0 kg versus BT: 4.5 kg (P < 0.01)At 12 months: CBT: 10 kg versus BT: 4.3 kg (P < 0.01)CBT + D/E versus CBTalone (1)At 3 months: CBT + D/E: 1.9 kg versus CBT alone: +0.5 kg* The number and BMI of patients for each camparison were not available; all patients were overweight or obeseBariatric treatments for adult obesity 138
Table T.F.1-3: Weight loss – PharmacotherapyReview Orlistat Sibutramine RimonabantPadwal et al., 2004 20Orlistat studies:N of trials: 16N of pts: 10,631;mean BMI 36.3 kg/m 2Sibutramine studies:N of trials: 10N of pts: 2623;mean BMI 35.1 kg/m 2Rimonabant studies:N of trials: fourN of pts: 6635;mean BMI 36.5 kg/m 2Weight or % weight: all 16 RCTs reported greater (2.9 kg,95% CI: 2.5 to 3.2 or 2.9%; 95% CI: 2.5% to 3.4%) WL inthe orlistat group, as compared to the placebo group.Absolute WL slightly greater in patients with lower baselineCV risk (3.0 kg; 95% CI: 2.4 to 3.6; 7 trials), as compared topatients with higher baseline CV risk (2.8 kg; 95% CI: 2.4 to3.1; eight trials); similar results for % WL.In patients with diabetes, orlistat reduced weight by 2.6%(95% CI 2.2 to 3.1%; five trials) or 2.3 kg (95% CI 1.6 to 3.0kg; 4 trials), as compared to placebo.Orlistat increased the frequency of successful 5%responders by 21% (95% CI 18% to 24%; 14 trials) or 10%responders by 12% (95% CI 9% to 14%; 13 trials), ascompared to placebo.BMI: Orlistat significantly reduced BMI (1.1 kg/m 2 , 95%CI: 0.7 to 1.4; three trials), as compared to placebo.WC: Orlistat significantly reduced WC (2.1 cm, 95% CI 1.3to 2.9; 9 trials)Weight or % weight: patients lost 4.2 kg (95% CI: 3.6to 4.7; 8 trials) or 4.3% (95% CI: 3.7% to 5.0%; 10 trials)more weight than those taking placebo.Absolute WL for patients at higher CV risk was 4.3 kg(95% CI: 3.7% to 5.0%; 7 trials) versus 4.0 (95% CI:3.0% to 5.0%; 5 trials) or 3.9% (95% CI: 2.1% to 5.7%; 3trials) for patients at lower CV risk.Sibutramine increased the frequency of successful 5%responders by 32% (95% CI: 27% to 37%; 7 trials) and10% responders by 18% (95% CI: 11% to 25%; 7 trails),as compared to placebo.In patients with diabetes, sibutramine reduced weight by5.0% (95% CI: 3.8 to 6.2%; 3 trials) or 4.9 kg (95% CI:3.6 to 6.2 kg; three trials), as compared to placebo.Three studies reported that 10% to 30% moresibutramine-treated patients maintained 80% to 100% ofthe initial WL, as compared to placebo (P < 0.05).BMI: Absolute reduction in BMI was 1.5 kg/m 2 (95%CI: 1.3 to 1.8; five trials).WC: Absolute reduction in WC was 4.0 cm (95% CI: 3.3to 4.7; eight trials).Weight: Rimonabant-treatedpatients lost 4.7 kg (95% CI: 4.1to 5.3; four trials) more weightthan those taking placebo.No sensitivity analysisconducted according to baselineCV risk because all studiesenrolled patients with CV riskfactors.Rimonabant increased thefrequency of successful 5%responders by 33% (95% CI:29% to 37%; 4 trials) and 10%responders by 19% (95% CI:15% to 23%; seven studies), ascompared to placebo.WC: Rimonabant reduced WCby 3.9 cm (95% CI: 3.3 to 4.5;four trials).Li et al., 2005 60Orlistat studies:N of trials: 29N of pts: NA;mean BMI 36.7 kg/m 2At 1 year (22 trials): the pooled estimate of the mean WL fororlistat-treated patients as compared to placebo recipientswas 2.89 kg (95% CI: 2.27 to 3.51).No effects of quality score and year of publication onoutcomes were detected. Sensitivity by drug dose was notpossible.Sensitivity analysis by follow-up rate: the pooled estimate of15 studies with follow-up rates of 70% or more was a meanWL of 2.83 kg (95% CI: 2.0 to 3.6 kg), as compared toplacebo; when 80% was used as the cut-off, no effect ofcompleteness of follow-up on outcome was detected.Only reported results from another meta-analysisNABariatric treatments for adult obesity 139
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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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follow-up time was 3 years. Results
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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 150 and 151: 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
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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 192 and 193: Weight management program (WMP) ver
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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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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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