Bariatric treatments for adult obesity - Institute of Health Economics

More documents

Recommendations

Info

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
Page 1 and 2:
Alberta STE ReportBariatric treatme
Page 3 and 4:
Alberta STE ReportBariatric treatme
Page 5 and 6:
EXECUTIVE SUMMARYSocial and System
Page 7 and 8:
Three surgical procedures—adjusta
Page 9:
Costs of Bariatric Surgery and Pote
Page 12 and 13:
Regulatory status .................
Page 14 and 15:
TABLES AND FIGURESSection One: Soci
Page 16 and 17:
ABBREVIATIONSAll abbreviations that
Page 18 and 19:
LYMmMAMDMUHCNANHLBINHSNICENIHNNHNPH
Page 20 and 21:
Bariatric physician: a licensed Doc
Page 22 and 23:
High-density lipoprotein (HDL): a f
Page 24 and 25:
Very-low-calorie diet (VLCD): a die
Page 26 and 27:
Additional Internet searches were c
Page 28 and 29:
This report addresses obesity in ad
Page 30 and 31:
Many systemic factors have been ide
Page 32 and 33:
Severe obesity is associated with d
Page 34 and 35:
eport their height and under-report
Page 36 and 37:
Also using self-reported data from
Page 38 and 39:
An examination of overall obesity d
Page 40 and 41:
Table S.2 presents the associationa
Page 42 and 43:
• have multiple focal points and
Page 45 and 46:
The main problem in any weight mana
Page 47:
food, and a negative body image. As
Page 50 and 51:
directly causes death. 61 To the ex
Page 52 and 53:
The addition of a selected pharmaco
Page 54 and 55:
lack of formal training in nutritio
Page 56 and 57:
slightly more likely to have prescr
Page 58 and 59:
selection criteria, have facilities
Page 60 and 61:
Barriers to using appropriate baria
Page 62 and 63:
Overview of adult obesityOver the p
Page 64 and 65:
the need for regular physical activ
Page 66 and 67:
phenylpropanolamine/25. Sibutramine
Page 68 and 69:
Complianceand AdherenceDemand andut
Page 70 and 71:
Aetna Clinical PolicyBulletinswww.a
Page 72 and 73:
Overweight 123,821 172,971 157,623
Page 74 and 75:
REFERENCES1. 2006 Canadian clinical
Page 76 and 77:
34. Gostin LO. Fast and supersized:
Page 78 and 79:
69. Klarenbach S, Padwal R, Wiebe N
Page 80 and 81:
105. Hill JO, Thompson H, Wyatt H.
Page 82 and 83:
141. Ross R, Bradshaw AJ. The futur
Page 84 and 85:
172. Arkinson J, Ji H, Fallah S, Pe
Page 86 and 87:
This section will address a set of
Page 88 and 89:
dietary therapy is to reduce total
Page 90 and 91:
Additional benefits of exercise ove
Page 92 and 93:
medications that inhibit intestinal
Page 94 and 95:
Rimonabant may be considered for pa
Page 96 and 97:
Long-term complications are specifi
Page 98 and 99:
Devices used for bariatric surgeryH
Page 100 and 101:
Description of the Included Systema
Page 102 and 103:
AEs for sibutramineAs compared to a
Page 104 and 105:
Evidence on Efficacy/EffectivenessW
Page 106 and 107:
Table T.7: Effects of behavioural t
Page 108 and 109:
SurgeryDescription of the included
Page 110 and 111:
follow-up time was 3 years. Results
Page 112 and 113:
group as compared to the VBG group.
Page 114 and 115:
The authors identified many methodo
Page 116 and 117:
The investigators pointed out that
Page 118 and 119:
approximately 3 to 5 kilograms. For
Page 120 and 121:
for studies with a mean age of part
Page 122 and 123:
Examining whether use of any of the
Page 124 and 125:
Evidence from placebo-controlled cl
Page 126 and 127:
colorectal or gastroesophageal or f
Page 128 and 129:
Web of ScienceISI Interface License
Page 130 and 131:
AMA Clinical PracticeGuidelineswww.
Page 132 and 133:
critical appraisal of the included
Page 134 and 135:
APPENDIX T.B: EXCLUDED STUDIESTable
Page 136 and 137:
Padwal R, Li SK, Lau DC. Long-term
Page 138 and 139:
Quality subsection 1: At least MEDL
Page 140 and 141:
Quality subsection 5a:Study quality
Page 142 and 143:
Partially reported: The study types
Page 144 and 145:
Table T.C.1: Results of quality ass
Page 146 and 147:
Table T.C.1: Results of quality ass
Page 148 and 149:
APPENDIX T.D: CHARACTERISTICS OF SY
Page 150 and 151:
Table T.D.1: Characteristics of the
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
APPENDIX T.E: EVIDENCE TABLE ON SAF
Page 158 and 159:
Serious surgical complicationsSurgi
Page 160 and 161:
LSGmMAMDNAnssORQoLRCTRDRRRYGBSBPTGV
Page 162 and 163:
Table T.F.1-2: Weight loss - Behavi
Page 164 and 165: Table T.F.1-4: Weight loss - Surger
Page 166 and 167: Table T.F.2: Quality of life (QoL)
Page 168 and 169: Curioni & Lourenco 2005 58Cholester
Page 170 and 171: Table T.F.3-3: Risk factors/comorbi
Page 172 and 173: Table T.F.3-5: Long-term effects of
Page 174 and 175: Maciejewski et al., 2005 65Avenell
Page 176 and 177: Table T.G.2: Effects of bariatric s
Page 178 and 179: Table T.G.4: Effects of bariatric s
Page 180 and 181: 18. Cerulli J, Lomaestro BM, Malone
Page 182 and 183: 50. Health Canada Drug Product Data
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
Page 190 and 191: concluded that adding orlistat to L
Page 192 and 193: Weight management program (WMP) ver
Page 194 and 195: groups. Compared with standard care
Page 196 and 197: Results from Analysis of Provincial
Page 198 and 199: DiscussionThe objectives of the eco
Page 200 and 201: surgical suites, and so on. The bud
Page 202 and 203: APPENDIX E.A: LITERATURE SEARCH SUM
Page 204 and 205: CRD Databases(DARE, HTA & NHS EED)h
Page 206 and 207: Web of ScienceISI Interface License
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
show all

Bariatric treatments for adult obesity - Institute of Health Economics

Create successful ePaper yourself

Delete template?

Save as template?