Bariatric treatments for adult obesity - Institute of Health Economics

For studies that evaluated WMP, the specific interventions and patient population included in theevaluations varied. In a study conducted in the United States, a weight-wise intervention programwas compared to no intervention for low-income women with a BMI between 25 kg/m 2 and 45kg/m 2 . In another study, conducted in Spain, a walking program was compared with best care (thatis, routine care with a recommendation to increase physical activity) for moderately depressed elderlywomen with a BMI between 25 kg/m 2 and 39.9 kg/m 2 . However, in a study conducted in theNetherlands, a community-based intervention program was compared with intensive LM for thegeneral population and overweight individuals. All these studies showed that the WMPs were costeffective,when compared with no intervention or best care.For studies that evaluated various LM programs in comparison with other LM programs or notreatment, the patient populations and interventions under examination varied. For instance, someincluded GP or dietician counselling versus no counselling for patients with a BMI ≥ 30 kg/m 2 andwith a high risk for ischaemic heart disease (IHD), 28 while others compared LCD versus standarddiet for patients with a BMI ≥ 43 kg/m, 2,29 or diet and exercise versus lifestyle education for patientswith a BMI ≥ 28 kg/m 2 and knee osteoarthritis, 30 or lifestyle intervention versus standard care forpatients with a BMI between 25 kg/m 2 and 35 kg/m. 2,31 (Refer to Results section for further detailsregarding these interventions.) Overall, the studies showed that LM was cost-effective with a costper QALY gained less than the conventional cost-effectiveness threshold of $50,000.The analysis of provincial health utilization data linked with the CCHS indicated that, compared tothe costs for individuals of normal weight, the health service costs associated with obesity areincreased by $217. This translates to an estimated $100 million economic burden of diseaseassociated with obesity. Furthermore, higher cost and resource utilization were associated withfactors including female, older age, lower household income, lower education, physical inactivity,and the presence of comorbidities.The analysis of provincial health utilization data indicated that the mean cost of inpatient andphysician services associated with bariatric surgery in 2006 was $12,176 per surgery. This analysisshowed that health service utilization and costs for the two years following surgery were greater thanfor the two years preceding surgery. However, when examining the marginal change in health serviceutilization and costs, the analysis showed an upward trend in the two years preceding surgery and adownward trend in the two years following surgery. Although this may suggest that bariatric surgerymay alter the upward trajectory of health service utilization for severely obese patients whounderwent surgery, it is important to note that the value in 2008 was still greater than that observedin 2005. Hence, it is uncertain whether the decrease is simply a return to pre-surgical levels. Still,these results are consistent with findings published elsewhere. In a US study 32 that examined thehealthcare utilization of inpatient services before and after RYGB, it was found that the rate ofhospitalization in the year post-operation was more than double compared to the rate in the yearpreceding RYGY. Furthermore, in an observational study conducted in Québec, 33 a downward trendwas found in hospital costs over the five years following bariatric surgery.Importantly, the cost estimate of bariatric surgery does not include services that may have beenprovided prior to admission and after discharge from hospital (for example, pre-surgical counsellingconducted prior to admission to hospital and post-surgical support following discharge) due tounavailability of data at the time of the analysis. However, the CADTH review of bariatric surgerydid conduct a budget impact for RYGB or LAGB. 1 Cost categories included the cost of pre-surgicalconsultation (including bariatric specialist time, dietician follow-up, and laboratory and other testing)post-surgical follow-up with a bariatric specialist, surgery, hospital stay, and surgical complication.Cost categories did not include capital expenses for improving capacity, such as additional dedicatedBariatric treatments for adult obesity 175