Bariatric treatments for adult obesity - Institute of Health Economics

ResultHealth outcomesCostsMarginal analysisConclusionOf a total of 401 participants, 243 were in dietician group and 158 in GP group; 377 werewithout IHD (243 in GP group and 134 in dietician group).Life years gained: 0.0274 versus 0.0919 in dietician versus GP group; 0.0919 versus 0.1608for those without IHDTotal costs: Dkr 1642 versus 755 in dietician versus GP groupCompared with no counselling, the ICER was Dkr 8,213 and Dkr 59,987 per LY gainedin GP and dietician group, respectively; for patients without IHD, ICER decreases to Dkr4670 and Dkr 23,469, respectively.Nutritional counselling by a GP or a dietician was cost-effective for obese patients with ahigh risk of IHD. Intervention by a GP was superior to that by a dietician.4 Study 24 Authors/publish year: Malone /2005; country: US; study type: CEA; setting: secondarycare; study perspective: payerObjectiveTo assess the cost-effectiveness of sibutramineplus a WMP for overweight and obesepatients.Population Individuals aged 18 years or older with a BMI ≥ 30 kg/m 2 or a BMI of 27 kg/m 2 to 29.9kg/m 2 with one or more co-morbidities, including diabetes, hypertension, orhyperlipidaemia.InterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesCostsSibutramine plus a WMP was compared with WMP alone. The WMP was a physiciansupervised,multidisciplinary program, including five monitored care visits.12 months/NAUS$/2004Of 501 patients included in the study, 281 were randomized to the intervention group and220 to the control group (WMP alone). The groups were not comparable in terms ofpatient demographics and BMI at baseline.In the intervention versus control group, the mean weight loss at 12 months was 13.7versus 5 pounds; per cent change in weight was -6% versus -2.2%; and per cent havingweight loss of at least 10% was 19.6% versus 10%.The median increase in total costs from 12 months before enrolment to 12 months afterenrolment was $1279 in the intervention group and $271 in the control group; the medianincrease in obesity-related costs was $408 versus $31 in both groups.Marginal analysisConclusionWhen total costs were considered, the mean ICER of intervention over control groupwas $194 per additional pound reduced; $399 per percentage change in weight loss.When obesity-related costs were considered, the mean ICER of intervention over controlgroup was $44 per additional pound reduced; $101 per percentage change in weight loss.Adding sibutramine to a WMP led to a significantly greater reduction in weight, but nosavings in costs.Bariatric treatments for adult obesity 188