Bariatric treatments for adult obesity - Institute of Health Economics

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CostsMarginal analysisThe cost analysis considered medication costs and direct healthcare costs of obesity- anddiabetes-related complications.Total costs: not reportedThe ICER was €14,000 and €13,600 per QALY gained, in Sweden and Switzerland,respectively.ConclusionThe analysis supported the use of orlistat for overweight and obese patients with T2DM.7 Study 23 Authors/publish year: Lamotte/2002; country: Belgium; study type: CEA; setting: primarycare; study perspective: healthcare consumerObjectivePopulationInterventionTime Horizon/discount rateCurrency/priceyearTo assess clinical and economic consequences of treating obese patients with T2DM withorlistat as compared to no treatment.Patients with obesity and T2DM.Treatment with orlistat was compared with placebo.10 years/3%€/2000ResultHealth outcomesA Markov model that incorporated obesity- and diabetes-related complications wasconstructed to predicted health outcomes and costs over a long run for four sub-groups:patients with event-free profiles, those with arterial hypertension and withouthypercholesterolaemia at the beginning of the study, those with hypercholesterolaemiabut without arterial hypertension at the beginning of the study, and those with arterialhypertension and hypercholesterolaemia.Compared to placebo, orlistat generated an incremental LY of 0.08, 0.204, 0.227, and0.474 for the sub-groups, respectively.Costs Compared to placebo, the incremental costs for those patient groups were €1608, €1514,€1678, and €1641, respectively.Marginal analysis Compared to placebo, the cost per LY saved was €19,986, €7,407, €7388, and €3462,respectively.ConclusionOrlistat was a cost-effective option for the treatment of obese patients with T2DM.8 Study 15 Authors/publish year: Lacey/2005; country: Ireland; study type: CUA; setting: primarycare; study perspective: healthcare systemObjectivePopulationTo assess the cost-effectiveness of the adding orlistat to a calorie-controlled dietoverweight and obese patients.Individuals aged 18 or older with a BMI ≥ 28 kg/ m 2 , no diagnosed T2DM, and beingable to lose 2.5 kg during 4 weeks before starting treatment.InterventionTime Horizon/discount rateThe orlistat in combination with a calorie-controlled diet was compared with diet alonefor overweight and obese patients.11 years/3%Bariatric treatments for adult obesity 190
Currency/priceyearResultHealth outcomes€/2003Clinical evidence was derived from five RCTs that included 1386 patients.Compared with diet alone, the QALY gain was 0.028 in orlistat patients and 0.09 inorlistat responders.Costs The incremental cost associated with orlistat versus diet alone was €478.Marginal analysisConclusionThe ICER for orlistat versus diet was €16,954 per QALY gained.Orlistat is effective and cost-effective in obese patients if, after 3 months of treatment,only treatment responders continue treatment.9 Study 16 Authors/publish year: Iannazzo/2008; country: Italy; study type: CUA; setting: primarycare; study perspective: societyObjectiveTo assess the cost-effectiveness of orlistat in combination with lifestyle modification forthe treatment of obesity.Population Individuals aged ≥ 35 years with a BMI ≥ 30 kg/m 2InterventionOrlistat in combination with lifestyle modification was compared with lifestylemodification alone. The lifestyle modification included a reduced-calorie diet and exercise.Time Horizon/discount rateCurrency/priceyear10 years/3.5%€/NAResultHealth outcomesCostsA Markov model that incorporated impact of obesity and diabetes on cardiovascularmortality was constructed to simulate the clinical and economic outcomes of theinterventions.Compared to placebo, orlistat led to a QALY gain of 0.046 (6.084 versus 6.13) and a LYgain of 0.014 (8.011 versus 8.026).The extra cost-per-patient in orlistat over placebo group was €2948 (€12,580 versus€15,530).Marginal analysis The incremental cost per QALY gained with orlistat over placebo was €75,310.ConclusionAdding orlistat to lifestyle modification provided the best value-for-money in the subgroupof obese patients with IGT.10 Study 17 Authors/publish year: Hampp/2008; country: US; study type: RCT/CUA; setting:primary care; study perspective: payerObjectivePopulationInterventionTo assess the clinical and economic impact of rimonabant in combination with lifestylemodification for the treatment of obesity.Individuals aged ≥ 18 years with a BMI ≥ 30 kg/ m 2 or a BMI ≥ 27 kg/m 2 with treatedor untreated dyslipidaemia or hypertension.Five alternatives were examined: rimonabant at a daily dose of 20 mg plus lifestyleinterventions for one year; rimonabant plus lifestyle interventions for 1 year followed byplacebo plus lifestyle interventions for 1 year; rimonabant plus lifestyle intervention for 2years; placebo plus lifestyle interventions for 2 years; and no intervention. The lifestyleintervention was low-calorie diet and exercise.Bariatric treatments for adult obesity 191
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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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Table T.F.1-2: Weight loss - Behavi
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Page 184 and 185: SECTION THREE: ECONOMIC EVALUATIONC
Page 186 and 187: Definition of bariatric surgical pa
Page 188 and 189: etween surgical interventions, the
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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
Page 210 and 211: Table E.A.2: Evidence table of revi
Page 212 and 213: ResultHealth outcomesCostsMarginal
Page 216 and 217: Time Horizon/discount rateCurrency/
Page 218 and 219: Objectivestudy perspective: society
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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