Bariatric treatments for adult obesity - Institute of Health Economics

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SECTION THREE: ECONOMIC EVALUATIONCharles Yan, PhD, Andy Chuck, PhD, MPHECONOMIC ANALYSIS (E)Objectives and Policy QuestionsThe objective of the economic analysis was to address the following issues:1. Cost comparisons (effectiveness or utility analyses) in the short-term and in the long-termand the potential for one treatment strategy to replace another in a given sub-population.2. Unit cost estimates, including physician billings, hospitalization or facility operational costs,other service costs and capital costs, for the procedure as well as related health services.3. Estimates of patient and public demand, including prevalence and incidence of condition(s);utilization rates of standard or alternative treatments, where data exist; and estimates of theuse of the new technology taking into account service capacity, where feasible, as well asappropriate clinical indicators for use.Issue 1 was addressed by a systematic review of the economic literature to determine thecomparative cost-effectiveness of alternative interventions for obesity. Issue 2 was addressed byconducting a secondary analysis of provincial health service utilization data to estimate the directhealth services cost associated with bariatric surgery in Alberta. Issue 3 was addressed by conductinga secondary analysis of provincial health utilization data linked with the 2007 Canadian CommunityHealth Survey (CCHS) to estimate the economic burden of disease associated with obesity inAlberta.MethodsReview of economic studiesSearch strategySelected databases were searched for economic evaluation studies of bariatric services publishedfrom 2000 to April 2010. Core Databases searched include MEDLINE, EMBASE, CINAHL, andWeb of Science, along with the Cochrane Database of Systematic Reviews (CDSR) and the Centrefor Reviews and Dissemination Databases (DARE, NHS EED, and HTA). Refer to Table E.A.1 inAppendix E.A for the detailed search strategy.Selection criteriaThe search was limited to human and English-language publications. Studies investigating theeconomic, health service utilization, or cost impact of bariatric services for adults on the healthsystem were included. Opinion articles (for example, opinions or letters to the editor) and abstractswere excluded. The selection of potentially relevant studies was reviewed by one reviewer.A recent 2010 CADTH report of bariatric surgeries 1 has been published that included a systematicreview of relevant health economic literature relating to bariatric surgeries and a primary costeffectivenessmodel comparing alternative bariatric surgical procedures, including standard care.Articles that were reviewed by the CADTH report 1 are not reviewed here; but rather a synthesis oftheir findings will be conducted. However, findings from the primary cost-effectiveness model willbe reviewed in this report.Bariatric treatments for adult obesity 160
Data extractionData extracted from studies include study design, objective, perspective, timelines, bariatricinterventions under investigation, country, health and cost outcomes, results from marginal analysis,and study conclusions.Quality assessment criteriaAn informal quality assessment of economic studies was conducted using criteria adapted fromDrummond et al. 2 and Drummond et al. 3 The purpose of providing a quality assessment ofeconomic studies in this report is to identify the components included in the studies and to providea general assessment of the quality of the economic studies reviewed. The quality of potentiallyrelevant studies was assessed by one reviewer.Secondary analysis of Provincial Health Utilization databasesSource of informationInformation on costs and resource utilization were retrieved from three provincial health utilizationdatabases between 2004 and 2008 fiscal years. The Alberta Physician Claims Database (PCD)provided information related to billing services to physicians for medically insured services inAlberta. The Alberta Discharge Abstracts Database (DAD) provided information related to hospitalinpatient procedures. The Ambulatory Care Classification System (ACCS) provided informationrelated to outpatient procedures. Note that cost data in the DAD and ACCS include patient-specificdrug and supply costs, functional centre direct costs such as salaries (excluding physician services),medical and surgical supplies, and functional center indirect costs such as administration andsupport services (Alberta Case Cost Report, Alberta Health and Wellness, December 2009).AnalysisThe analysis consisted of two components. The first was an estimate of the direct health servicecosts of bariatric surgery. Patients who received bariatric surgery in 2005–2006 were identified usingthe Canadian Classification of Health Interventions (CCI) codes (see below) that corresponded tobariatric surgery. Total physician and inpatient costs for each patient with a corresponding CCI codewere calculated by aggregating all costs of physician and inpatient services provided within the datesof admission and discharge. A mean cost per bariatric surgery was then calculated by divided thetotal cost of bariatric surgery across all patients by the number of patients in the cohort.The second component was a pre-post analysis comparing the health service utilization before andafter surgery. For the cohort of patients who received bariatric surgery in 2005–2006, total physician,inpatient, and outpatient visits and costs were calculated across all patients, over a period of 2 yearsbefore and 2 years after surgery. Total physician, inpatient, and outpatient visits and costs weredivided by the number of patients in the cohort to provide a mean visit and a cost per patient. Themean visit and costs before and after surgery were then compared to each other. Note that all costswere adjusted to reflect 2006 dollars using the Alberta Consumer Price Index (CPI). Furthermore,visits or costs that were greater than three times its standard deviation in each year were censoredfrom the analysis.Bariatric treatments for adult obesity 161
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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
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Web of ScienceISI Interface License
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AMA Clinical PracticeGuidelineswww.
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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 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 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
Page 226 and 227: 15. Lacey LA, Wolf A, O'shea D, Ern
Page 228 and 229: Author Contribution StatementsPaula
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