Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.F.1-4: Weight loss – SurgerySurgeryKlarenbach et al., 2010 38Studies comparing surgery withanother surgery or standardcare:N of trials: 31N of pts: NA; mean BMI rangedfrom 42 to 58 kg/m 2Studies comparinglaparoscopic with open surgery:N of trials: eightN of pts: NA; mean BMI rangedfrom 42 to 51 kg/m 2Weight lossSurgery versus another surgery or standard care (diet and exercise)At 1 year (15 trials, 1103 pts):Network analysis:* Ranking of the effectiveness for reducing BMI (from most to least efficacious): JB, loop gastric bypass, mini-gastric bypass,BPD, sleeve gastrectomy, RYGB, HG, VBG, AGB, and standard care.Network analysis: RYGB produced significantly greater decreases in BMI from baseline than did AGB (MD 6.6; 95% CrI:**: 9.5 to 3.4) andstandard care (MD 8.6; 95% CrI: 1.6 to 2.2); direct evidence supported the findings of network analysis for RYGB versus AGB (MD 5.8;95% CI: 9.7 to 1.9; 2 trials), although statistical heterogeneity was large.At 2 years (10 trials, 813 pts):Ranking of efficacy by network analysis: JB, BPD, mini-gastric bypass, AGB with omentectomy, RYGB, HG, VBG, and AGB.Network analysis: RYGB produced significantly greater decreases in BMI than did VBG (MD 4.1; 95% CrI:7.0 to 1.9] and AGB (MD 8.0;95% CrI: 10.9 to 5.1); direct evidence was available and supportive for RYGB versus VBG (4.7; 95% CI: 6.1 to 3.2; 3 trials), and RYGBversus AGB (7.2; 95% CI: 8.9 to 5.5; 1 trial)No BMI data were available at 2 years for loop gastric bypass, sleeve gastrectomy, HG, gastrogastostomy, or standard care.At 3 to 5 years (seven trials, 416 pts):Ranking by network analysis: similar to year 1 and year 2: JB, RYGB, VBG, AGB.Network analysis: RYGB produced significantly greater decreases in BMI from baseline than did AGB (MD 7.7; 95% CrI: 15.1; 0.01); directevidence was available and supportive for RYGB versus AGB (6.4; 95% CI: 7.9 to 4.9; 2 trials); no other result from network analysis wassignificant.No data were available during this period for BPD, loop gastric bypass, mini-gastric bypass, AGB with omentectomy, gastrogastostomy, orsleeve gastrectomy.Laparoscopic versus open approachesAt 1 year (five trials, 234 pts):Small but significantly greater decrease in BMI in the laparoscopic surgery group as compared to the open surgery group (MD 1.2 kg/m 2 ; 95%CI: 2.2 to 0.2; five trials)Two trials reported changes in BMI between three and five years; the difference was not statistically significant.* Network analysis: pooling data from studies that are not directly compared but are linked via one or more common comparators.** Credible interval (CrI): used for mixed (direct and indirect) and indirect evidenceBariatric treatments for adult obesity 140
Table T.F.1-4: Weight loss – Surgery (cont’d)SurgeryColquitt et al., 2009 62Weight lossSurgery versus non-surgical treatmentThree RCTs indicated that regardless of the surgical intervention used or the types of patients included, all studies reporting a statistical comparisonfound statistically significant benefits on measures of weight change as compared to no surgery at 2- to 3-year follow-up.Comparison of different surgeriesLRYGB versus LAGBOne small RCT showed that, on a variety of measures of weight, LRYGB was superior to LAGB.LRYGB versus LSGOne small RCT showed that BMI and weight loss at 12-month follow-up were similar between LRYGB and LSG group; per cent excess weight losswas greater with sleeve gastrectomy at 12 months (not statistically significant).LAGB versus LISGOne RCT demonstrated that in all measures of weight change (% of excess weight loss, BMI, body weight) patients undergoing LISG showed moreimprovement than patients undergoing LAGB.Open versus laparoscopic proceduresOpen versus laparoscopic gastric bypassFour RCTs showed that weight loss was comparable between open and laparoscopic gastric bypass.Open versus laparoscopic adjustable gastric bandingOne RCT showed that open and laparoscopic surgeries to fit adjustable silicone gastric banding led to comparable degrees of significant weight loss.Bariatric treatments for adult obesity 141
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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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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
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 160 and 161: LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
Page 162 and 163: Table T.F.1-2: Weight loss - Behavi
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
Page 200 and 201: surgical suites, and so on. The bud
Page 202 and 203: APPENDIX E.A: LITERATURE SEARCH SUM
Page 204 and 205: CRD Databases(DARE, HTA & NHS EED)h
Page 206 and 207: Web of ScienceISI Interface License
Page 208 and 209: NEOS Librarywww.library.ualberta.ca
Page 210 and 211: Table E.A.2: Evidence table of revi
Page 212 and 213: 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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ResultHealth outcomesCostsMarginal
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ResultHealth outcomesCostsMarginal
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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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