Bariatric treatments for adult obesity - Institute of Health Economics

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Table T.G.4: Effects of bariatric surgery on cancer, mortality, and adverse eventsSurgery group Control group Effect size/P-value (95% CI)Cancer incidenceTotal:126/2010173/20370.71 (P = 0.003)First-time cancer (10 years):In women:11779169130HR 0.67, 95% CI 0.53 to 0.85, P = 0.0009HR 0.58, 95% CI 0.44 to 0.77, P = 0.0001In men:3839HR 0.97, 95% CI 0.62 to 1.52, P = 0.90Mortality (at mean follow-upof 10.9 years)Overall mortality:101/2010 (5.0%)129/2037 (6.3%)Deaths due to cardiac events:13/201025/2037Deaths due to cancer:29/201047/2037Adverse eventsMortality 90-days post surgery:No. of patients withcomplications:5/2010 (0.25%)(4 peritonitis with organfailure; 1 sudden death)151/1164 (13%)2/2037 (0.10%) (1 pancreatic cancer; onealcohol-related)Post-operation requiringreoperation:26/1164 (2.2%)Reoperation or conversion:N = 1338 (for at least 10-year follow-up)Banding: 31%VBG: 21%Gastric bypass: 17%Bariatric treatments for adult obesity 154
REFERENCES1. Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E, et al. Canadian clinicalpractice guidelines on the management and prevention of obesity in adults and children.CMAJ 2007;176(8):S1-S12. Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, et al. Systematic review ofthe long-term effects and economic consequences of treatments for obesity and implicationsfor health improvement. Health Technology Assessment 2004;8(21).3. Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weightloss. Nature Clinical Practice Endocrinology & Metabolism 2007;3(7):518-29.4. Tsigos C, Hainer V, Basdevant A, Finer N, Fried M, Mathus-Vliegen E, et al. Management ofobesity in adults: European clinical practice guidelines. Obesity Facts 2008;1(2):106-16.5. Lang A, Froelicher ES. Management of overweight and obesity in adults: behavioralintervention for long-term weight loss and maintenance. European Journal of CardiovascularNursing 2006;5(2):102-14.6. Bray GA. Lifestyle and pharmacological approaches to weight loss: efficacy and safety. Journalof Clinical Endocrinology & Metabolism 2008;93(11 Suppl 1):S81-S88.7. Clifton PM. Dietary treatment for obesity. Nature Clinical Practice Gastroenterology & Hepatology2008;5(12):672-81.8. Dubnov-Raz G. The dietary treatment of obesity. Endocrinology and Metabolism Clinics of NorthAmerica 2008;37(4):873-86.9. Katan MB. Weight-loss diets for the prevention and treatment of obesity. New England Journalof Medicine 2009;360(9):923-5.10. Aronne LJ, Wadden T, Isoldi KK, Woodworth KA. When prevention fails: obesity treatmentstrategies. American Journal of Medicine 2009;122(4:Suppl 1):S24-S32.11. Low AK, Bouldin MJ, Sumrall CD, Loustalot FV, Land KK. A clinician's approach to medicalmanagement of obesity. American Journal of the Medical Sciences 2006;331(4):175-82.12. Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. New England Journalof Medicine 2008;358(18):1941-50.13. Aditya BS, Wilding JPH. Modern management of obesity. Clinical Medicine 2009;9(6):617-21.14. Berkel LA, Poston WS, Reeves RS, Foreyt JP. Behavioral interventions for obesity. Journal ofthe American Dietitic Association 2005;105(5 Suppl 1):S35-S43.15. Shaw K, O'Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight orobesity. Cochrane Database of Systematic Reviews 2005;(2):003818.16. Ioannides-Demos LL, Proietto J, McNeil JJ. Pharmacotherapy for obesity. Drugs2005;65(10):1391-418.17. Bray GA. Medications for obesity: mechanisms and applications. Clinical Chest Medicine2009;30:525-38.Bariatric treatments for adult obesity 155
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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
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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
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Page 176 and 177: Table T.G.2: Effects of bariatric s
Page 180 and 181: 18. Cerulli J, Lomaestro BM, Malone
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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 198 and 199: DiscussionThe objectives of the eco
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Page 214 and 215: CostsMarginal analysisThe cost anal
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Page 218 and 219: Objectivestudy perspective: society
Page 224 and 225: S4Economic burden of obesityMean co
Page 226 and 227: 15. Lacey LA, Wolf A, O'shea D, Ern
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Author Contribution StatementsPaula
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