Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.G.2: Effects of bariatric surgery on weight loss and HrQoLWeight change/HrQoL Surgery Control Effect size/P-value (95% CI)% weight change at 2 yrs -23.4 (N = 1845) 0.1 (N = 1660) Difference 22.2 (21.6 to 22.8),P < 0.001% BMI change at 2 yrs -23.3 (N = 1845) 0.1 (N = 1845) 22.1 (21.5 to 22.7), P < 0.001Weight at 10 years (kg) 100.5 (±17.7) (N = 655) 115.2 (±19.9) (N = 621) P < 0.0001Weight change at 10 yrs (kg) -19.7 (±15.8) (N = 655) 1.3 (±13.8) (N = 621) P < 0.0001Weight % change at 10 yrs -16 (±12.1) (N = 655) 1.5 (±9.9) (N = 621)BMI at 10 yrs 35.3 (±5.4) (N = 655) 40.6 (±5.9) (N = 621)Change in BMI at 10 yrs -6.7 (±5.4) (N = 655) 0.7 (±4.9) (N = 621) P < 0.0001% weight loss at 10 yrs for eachsurgical procedure (proportion ofpatients followed)% weight loss at 15 yrs for eachsurgical procedure (proportion ofpatients followed)HrQoLCurrent health perceptions fromthe General Health Rating IndexSocial interaction from theSickness Impact ProfileOverall mood from the MoodAdjective Check ListObesity-related Problems scaleHospital Anxiety and DepressionscaleGBP: 25±11% (58/265)VBG: 16±11% (746/1369)Gastric banding: 14±14% (237/376)GBP: 27±12% (10/265)VBG: 18±11% (108/1369)Gastric banding: 13±14% (52/376)At 2 years, the surgery group had significant improvement in all HrQoL measures as compared to patients receiving conventional treatment.Bariatric treatments for adult obesity 152
Table T.G.3: Effects of bariatric surgery on risk factors/comorbiditiesRisk factors/comorbidities Surgery Control Effect size/P-value (95% CI)Incidence at 2 yrs 15/1489 (1%) 112/1402 (8%) OR 0.14 (0.08-0.24), P < 0.001DiabetesHypertensionHypertriglyceridemiaCardiovascular diseasemedicationIncidence at 10 yrs 36/517 (7%) 129/539 (24%) OR 0.25 (0.17-0.38), P < 0.001Recovery of DM at 2 yrs 246/342 (72%) 52/248 (21%) OR 8.42 (5.68-12.5), P < 0.001Recovery of DM at 10 yrs 42/118 (36%) 11/84 (13%) 3.45 (1.64-7.28), P < 0.001Incidence at 2 yrs 149/623 (24%) 223/770 (29%) OR 0.78 (0.60-1.01), P = 0.06Incidence at 10 yrs 88/215 (41%) 137/279 (49%) OR 0.75 (0.52-1.08), P = 0.13Recovery of HTN at 2 yrs 409/1204 (34%) 185/880 (21%) 1.72 (1.40-2.12), P < 0.001Recovery of HTN at 10 yrs 81/424 (19%) 38/342 (11%) OR 1.68 (1.09-2.58), P = 0.02Incidence at 2 yrs 58/731 (8%) 176/801 (22%) OR 0.29 (0.21-0.41), P < 0.001Incidence at 10 yrs 38/225 (17%) 75/281 (27%) OR 0.61 (0.39-0.95), P = 0.03Recovery of HTG at 2 yrs 683/1102 (62%) 187/850 (22%) OR 5.28 (4.29-6.49), P < 0.001Recovery of HTG at 10 yrs 185/402 (46%) 79/331 (24%) OR 2.57 (1.85-3.57), P < 0.001On medication at baseline N = 150 N = 125% on medication at 2 years 61.7 91.2 RR 0.69 (0.60, 0.80), P < 0.05% on medication at 6 years 64.7 86.4 RR 0.77 (0.67, 0.88), P < 0.0 5Not on medication at baseline N = 360 N = 330% on medication at 2 years 3.1 10.1 RR 0.28 (0.14, 0.56), P < 0.05% on medication at 6 years 13.3 16.7 RR 0.80 (0.56, 1.16)Bariatric treatments for adult obesity 153
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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.
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The authors identified many methodo
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The investigators pointed out that
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approximately 3 to 5 kilograms. For
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for studies with a mean age of part
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Examining whether use of any of the
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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 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 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
Page 214 and 215: CostsMarginal analysisThe cost anal
Page 216 and 217: Time Horizon/discount rateCurrency/
Page 218 and 219: Objectivestudy perspective: society
Page 224 and 225: 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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