Bariatric treatments for adult obesity - Institute of Health Economics

CaveatsIt is important to evaluate the evidence in light of the following caveats.1. Cost-effectiveness was addressed using evidence from the published literature. With theexception of the CADTH review, 1 the extent to which the evidence from the publishedliterature can be generalized to the Alberta context is unknown due to local differences inclinical practice, epidemiology, and costs.2. The analysis of provincial health utilization data was limited to two years preceding and twoyears following surgery. Due to the short time horizon before and after surgery, it isuncertain whether the trends of increasing health service utilization prior to surgery anddecreasing health service utilization after surgery were reliable and valid (that is, thedownward trend could simply be the health service utilization returning to levels observedprior to surgery). It should be noted that no data was available beyond 2008, and thathistorical data going back further than 2 years is less relevant to the current Alberta context,due to the evolving nature of bariatric surgical techniques.3. The cost estimate for bariatric surgery only reflects the resources corresponding to thespecific CCI coding and therefore does not include services that may have been providedprior to admission and after discharge from hospital (for example, pre-surgical counsellingconducted prior to admission to hospital and post-surgical support following discharge).Hence the analysis underestimates the costs of bariatric surgery.4. Bariatric surgical procedures using laparoscopic versus open approaches were notdifferentiated in the analysis of provincial health utilization databases, due to data qualityissues regarding the coding of the surgical procedures. Consequently, the impact oflaparoscopic procedures on health service utilization and costs as compared to the impact oftraditional bariatric surgical approaches on those same elements is unknown.5. No inpatient cost data was available in the dataset that links health service utilization datawith the epidemiologic data contained in the 2007 CCHS, and the economic burden ofobesity in Alberta only included costs associated with physician and outpatient services.Consequently, the estimated burden of obesity in Alberta is underestimated.Bariatric treatments for adult obesity 177