Bariatric treatments for adult obesity - Institute of Health Economics

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LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPHSNSNSSOHTACORQALYQoLRCTRDRRRYGBRRSDSOSTCT2DMTGUKUS, USAVLCDlife yearmalemetremeta-analysismean differenceMcGill University Health Centredata not availableNational Heart, Lung, and Blood InstituteNational Health SystemNational Institute for Clinical ExcellenceNational Institutes of Healthnumber needed for harmNational Population Health Surveydifference not significantnot statistically significantOntario Health Technology Advisory Committeeodds ratioquality-adjusted life yearquality of liferandomized controlled trialrisk differencerisk ratioRoux-en-Y gastric bypassrelative riskstandard deviationSwedish obesity subjectstotal cholesterolType 2 diabetes mellitustriglyceridesUnited KingdomUnited States of Americavery-low-calorie dietBariatric treatments for adult obesity – March 2012xv
VBGWCWHOWHRWLWMPvertical banded gastroplastywaist circumferenceWorld Health Organizationwaist-to-hip ratioweight lossweight management program(s)GLOSSARY/DICTIONARYThe glossary terms listed below were obtained and adapted from the following sources:Hassen-Khodja R, Lance JMR. Agence d’évaluation des technologies et des modes d’intervention ensanté (AETMIS). Surgical treatment of morbid obesity; An update. Montréal (QC): AETMIS; 2006.Available from: www.aetmis.gouv.qc.ca/site/download.php?f=d76d1f910aff4f2e92bcbe0520e21bd8)(accessed 2010 June 18).www.emedicinehealth.com/obesity/glossary_em.htmwww.medicinenet.com/obesity_weight_loss/glossary.htmweightloss.about.com/od/glossary/g/abobesity.htmweightloss.about.com/od/glossary/Weight_Loss_Glossary.htmwww.wellnessproposals.com/glossaries/glossary-obesity-physical-activity-and-weight-controlglossary.htmwww.bmimedical.ca.htmlwww.bariatricedge.com/dtcf/pages/GlossaryTerms.htmwww.docshop.com/education/bariatrics/glossaryAbdominal obesity: the presence of excess fat in the abdominal area. It is typically measured bywaist circumference; a measurement of 40 inches or more in men and 35 inches or more in womenindicates abdominal obesity. Excess fat in the abdomen is considered an independent predictor ofrisk and morbidity, meaning the likelihood for developing diseases is higher for those withabdominal obesity.Absorption: the process in which digested food is absorbed by the lower part of the small intestineinto the bloodstream.Adipose tissue: connective tissue made up of adipocyte (fat) cells, in which the body stores fat inthe form of triglycerides.Amino Acids: the building blocks of protein. The human body uses 11 non-essential amino acids(produced by the human body) and nine essential amino acids (found in the diet; the human bodycannot produce them).Balanced Deficit Diet (BDD): a diet that subtracts a set number of calories from a person’s dailyexpenditures. BDDs are individualized diets and vary in their total calories.Bariatric: pertaining to bariatrics, which is the field of medicine concerned with weight loss.Bariatric treatments for adult obesity – March 2012xvi
Page 1 and 2: Alberta STE ReportBariatric treatme
Page 3 and 4: Alberta STE ReportBariatric treatme
Page 5 and 6: EXECUTIVE SUMMARYSocial and System
Page 7 and 8: Three surgical procedures—adjusta
Page 9: Costs of Bariatric Surgery and Pote
Page 12 and 13: Regulatory status .................
Page 14 and 15: TABLES AND FIGURESSection One: Soci
Page 16 and 17: ABBREVIATIONSAll abbreviations that
Page 20 and 21: Bariatric physician: a licensed Doc
Page 22 and 23: High-density lipoprotein (HDL): a f
Page 24 and 25: Very-low-calorie diet (VLCD): a die
Page 26 and 27: Additional Internet searches were c
Page 28 and 29: This report addresses obesity in ad
Page 30 and 31: Many systemic factors have been ide
Page 32 and 33: Severe obesity is associated with d
Page 34 and 35: eport their height and under-report
Page 36 and 37: Also using self-reported data from
Page 38 and 39: An examination of overall obesity d
Page 40 and 41: Table S.2 presents the associationa
Page 42 and 43: • have multiple focal points and
Page 45 and 46: The main problem in any weight mana
Page 47: food, and a negative body image. As
Page 50 and 51: directly causes death. 61 To the ex
Page 52 and 53: The addition of a selected pharmaco
Page 54 and 55: lack of formal training in nutritio
Page 56 and 57: slightly more likely to have prescr
Page 58 and 59: selection criteria, have facilities
Page 60 and 61: Barriers to using appropriate baria
Page 62 and 63: Overview of adult obesityOver the p
Page 64 and 65: the need for regular physical activ
Page 66 and 67: phenylpropanolamine/25. Sibutramine
Page 68 and 69:
Complianceand AdherenceDemand andut
Page 70 and 71:
Aetna Clinical PolicyBulletinswww.a
Page 72 and 73:
Overweight 123,821 172,971 157,623
Page 74 and 75:
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
Page 130 and 131:
AMA Clinical PracticeGuidelineswww.
Page 132 and 133:
critical appraisal of the included
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APPENDIX T.B: EXCLUDED STUDIESTable
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Padwal R, Li SK, Lau DC. Long-term
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Quality subsection 1: At least MEDL
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Quality subsection 5a:Study quality
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Partially reported: The study types
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Table T.C.1: Results of quality ass
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Table T.C.1: Results of quality ass
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APPENDIX T.D: CHARACTERISTICS OF SY
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Table T.D.1: Characteristics of the
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Page 154 and 155:
Page 156 and 157:
APPENDIX T.E: EVIDENCE TABLE ON SAF
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Serious surgical complicationsSurgi
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LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
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Table T.F.1-2: Weight loss - Behavi
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Table T.F.1-4: Weight loss - Surger
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Table T.F.2: Quality of life (QoL)
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Curioni & Lourenco 2005 58Cholester
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Table T.F.3-3: Risk factors/comorbi
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Table T.F.3-5: Long-term effects of
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Maciejewski et al., 2005 65Avenell
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Table T.G.2: Effects of bariatric s
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Table T.G.4: Effects of bariatric s
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18. Cerulli J, Lomaestro BM, Malone
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50. Health Canada Drug Product Data
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SECTION THREE: ECONOMIC EVALUATIONC
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Definition of bariatric surgical pa
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etween surgical interventions, the
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concluded that adding orlistat to L
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Weight management program (WMP) ver
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groups. Compared with standard care
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Results from Analysis of Provincial
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DiscussionThe objectives of the eco
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surgical suites, and so on. The bud
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APPENDIX E.A: LITERATURE SEARCH SUM
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CRD Databases(DARE, HTA & NHS EED)h
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Web of ScienceISI Interface License
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NEOS Librarywww.library.ualberta.ca
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Table E.A.2: Evidence table of revi
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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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Page 222 and 223:
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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