Bariatric treatments for adult obesity - Institute of Health Economics

Weight management program (WMP) versus no intervention or usual careGustafson et al. 25 assessed the cost-effectiveness of a 16-week weight loss program for low-incomewomen in the US in comparison with no intervention, using clinical and resource use data collectedfrom an RCT. The study adopted a payers’ perspective and was conducted over lifetime. Studypopulation comprised women between 40 and 60 years of age with a BMI between 25 kg/m 2 and 45kg/m 2 and an income ≤ 200% of the federal poverty level, 46% of whom had high blood pressure,29% of whom had high cholesterol, and 67% of whom were obese. The weight-wise interventionconsisted of weekly counselling sessions during a 16-week period, with a focus on consuming nineor more fruit and vegetable servings daily and lifestyle change through self-monitoring, problemsolving,and goal-setting. Cost categories were the costs of staff time, program materials, rental spaceand utilities/overhead. Results indicated that the WMP was associated with $1947 per life year saved,as compared to no intervention. The study concluded that the weight-wise intervention was a costeffectiveoption.Gusi et al. 26 used data from an RCT to assess the cost-effectiveness of a walking program in Spainover a 6-month period, compared to best care. The study population comprised women 60 years orolder with a BMI between 25 kg/m 2 and 39.9 kg/m 2 or 6 to 9 points in the 15-item GeriatricDepression Scale. The cost analysis was conducted from a payer’s perspective and considered healthsystem costs, including personnel time, facilities, medications and consultation. The walkingprogram consisted of walks with a group in public park or forest tracks, guided by the qualifiedexercise leaders, for 50 minutes, three times per week over 6 months. Individuals in best carereceived routine care with a recommendation to increase physical activity. Results indicated that theprogram was associated with a cost of $419 per QALY gained, as compared to best care. The studyconcluded that the walking program was cost-effective for depressed or overweight elderly women.Bemelmans et al. 27 conducted a Markov model to evaluate the clinical and economic impact of acommunity-based intervention and an intensive LM to reduce overweight prevalence, as comparedto no intervention. The community-based intervention offered social support such as self-helpgroups, risk factor screening and/or counselling to 90% of general population, and the intensive LMwas offered to 10% of the population and targeted at overweight individuals. The study adopted apayer’s perspective and was conducted over an 80-year horizon. Cost categories were the costs ofthe interventions and treatment for obesity-related morbidity. Results indicated that, compared to nointervention, the cost was $6878 per LY gained and $6743 per QALY gained for the communitybasedintervention, $11,328 per LY gained and $9980 per QALY gained for the intensive LM, and$8092 per LY gained and $7687 per QALY gained for the combination of both programs. The studyconcluded that both community-based intervention and intensive lifestyle modification were costeffectivefor preventing and reducing overweight, and that the former was slightly more costeffective.Lifestyle modification (LM) versus other LM or no interventionBesides the studies (described above) that evaluated LM versus other bariatric services, fourstudies 28-31 compared LM versus other LM or no treatment.Olsen et al. 28 used data from an RCT enrolling 401 patients to assess the cost-effectiveness ofnutritional counselling by a GP or a dietician for patients with a BMI ≥ 30 kg/m 2 and with a highrisk for ischaemic heart disease (IHD), as compared to no counselling. The counselling by GPsconsisted of general advice plus written information on health and diet, and the counselling bydieticians focused on principles of good nutrition and advice about food shopping, cookingBariatric treatments for adult obesity 168