Bariatric treatments for adult obesity - Institute of Health Economics

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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
5 Study 14 Authors/publish year: van Baal /2008; country: Netherlands; study type: CUA; setting:primary care; study perspective: payerObjectivePopulationInterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesCostsMarginal analysisConclusionTo assess the cost-effectiveness of orlistat in combination with low-calorie diet for thetreatment of obesity.Individuals aged between 20 and 70 years with a BMI ≥ 30 kg/m 2 , not being treated forobesity.No intervention was compared to treatment with orlistat plus low-calorie diet andtreatment with low-calorie diet alone.Lifetime/1.5% for effects and 4% for costs€/2005QALY gained: 31,000 and 17,000 in medication and diet group for the targetedpopulation of 1.14 million; LY: 34,000 versus 18,000 in medication and diet group for the1.14 millionDirect healthcare costs were considered and no productivity costs were considered.Incremental costs: €1,136 versus €302 million for the 1.14 million populations inmedication and diet group.ICER of diet over no intervention: €16,400 per LY gained and €17,900 per QALYsgained; ICER of medication plus diet over no intervention: €53,600 per LY gained and€58,800 per QALYs gained.The study suggested that a low-calorie diet was the first option for the treatment ofobesity.6 Study 22 Authors/publish year: Ruof /2005; country: Sweden and Switzerland; study type: metaanalysis/CEA;setting: primary care; study perspective: healthcare systemObjectivePopulationInterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesTo assess clinical and economic effects of orlistat on obese patients with T2DM.Patients with obesity and T2DM.Treatment with orlistat was compared with placebo.11 years/3%€/2001Meta-analysis was conducted to pool results from seven RCTs; 1249 and 1230 patientswere included in orlistat and placebo groups, respectively.After 12 weeks, 23% of patients in orlistat group achieved a weight reduction of morethan 5%; these patients demonstrated a mean decrease in H1C of 1.16% and a weight lossof 8.6 kg.Bariatric treatments for adult obesity 189
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Alberta STE ReportBariatric treatme
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Alberta STE ReportBariatric treatme
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EXECUTIVE SUMMARYSocial and System
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Three surgical procedures—adjusta
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Costs of Bariatric Surgery and Pote
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Regulatory status .................
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TABLES AND FIGURESSection One: Soci
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ABBREVIATIONSAll abbreviations that
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LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
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Bariatric physician: a licensed Doc
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High-density lipoprotein (HDL): a f
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Very-low-calorie diet (VLCD): a die
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Additional Internet searches were c
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This report addresses obesity in ad
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Many systemic factors have been ide
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Severe obesity is associated with d
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eport their height and under-report
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Also using self-reported data from
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An examination of overall obesity d
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Table S.2 presents the associationa
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• have multiple focal points and
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The main problem in any weight mana
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food, and a negative body image. As
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directly causes death. 61 To the ex
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The addition of a selected pharmaco
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lack of formal training in nutritio
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slightly more likely to have prescr
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selection criteria, have facilities
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Barriers to using appropriate baria
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Overview of adult obesityOver the p
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the need for regular physical activ
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phenylpropanolamine/25. Sibutramine
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Complianceand AdherenceDemand andut
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Aetna Clinical PolicyBulletinswww.a
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Overweight 123,821 172,971 157,623
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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
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AMA Clinical PracticeGuidelineswww.
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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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APPENDIX T.E: EVIDENCE TABLE ON SAF
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Serious surgical complicationsSurgi
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LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
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Page 186 and 187: Definition of bariatric surgical pa
Page 188 and 189: etween surgical interventions, the
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Page 192 and 193: Weight management program (WMP) ver
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Page 198 and 199: DiscussionThe objectives of the eco
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Page 208 and 209: NEOS Librarywww.library.ualberta.ca
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Page 214 and 215: CostsMarginal analysisThe cost anal
Page 216 and 217: Time Horizon/discount rateCurrency/
Page 218 and 219: Objectivestudy perspective: society
Page 220 and 221: ResultHealth outcomesCostsMarginal
Page 222 and 223: ResultHealth outcomesCostsMarginal
Page 224 and 225: S4Economic burden of obesityMean co
Page 226 and 227: 15. Lacey LA, Wolf A, O'shea D, Ern
Page 228 and 229: Author Contribution StatementsPaula
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