Bariatric treatments for adult obesity - Institute of Health Economics

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Time Horizon/discount rateCurrency/priceyearResultHealth outcomesCostsMarginal analysisConclusion5 years/3%US$/2006The incidence of coronary heart disease (CHD) was reduced from 1.16% with notreatment by 0.042% with placebo and by 0.083% with rimonabant for 2 years. Theincidence of diabetes was reduced from 5.06% with no treatment by 0.192% with placeboand by 0.470% with rimonabant for 2 years.QALYs gained were 0.0984 with rimonabant for 2 years, 0.0403 with placebo, and 0.0000with no treatment.The total costs per patient for each non-dominated strategy were: $6060.27 withrimonabant for 2 years, $1878.61 with placebo, and $851.41 with no treatment.The rimonabant plus lifestyle interventions for one year and rimonabant plus lifestyleinterventions for 1 year followed by placebo plus lifestyle interventions for 1 year weredominated options in that they generated lower QALYs gained at higher costs, comparedto other alternatives.The ICER of rimonabant for 2 years was $71,973.43 per QALY gained over placebo and$52,935.52 per QALY gained over no treatment.Rimonabant in combination with lifestyle interventions had the potential to decrease theincidence of obesity-related morbidity and to improve health-related quality of life, but ata considerable cost.11 Study 18 Authors/publish year: Brennan /2006; country: Germany; study type: CUA; setting:primary care; study perspective: payerObjectivePopulationInterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesTo assess the clinical impact and cost-effectiveness of sibutramine in combination withdiet and lifestyle counselling for the treatment of obesity.Individuals with a BMI ≥ 30 kg/m 2 without co-morbidities.Sibutramine in combination with diet and lifestyle advice was compared with diet andlifestyle counselling alone.5 years/5%€/2003The incremental QALY relating to weight loss, diabetes, and CHD of sibutramine overplacebo was 51.5 (20,290 with sibutramine versus 20,238 with placebo) for a cohort of1000 patients.Costs The incremental costs were €706,148 (€2,302,468 with sibutramine versus €1,596,320with placebo) for a cohort of 1000 patients.Marginal analysisConclusionThe ICER of sibutramine over placebo was €13,706 when considering the costs andbenefits associated with weight loss and reductions in CHD and diabetes events.Adding sibutramine to lifestyle modification was a cost-effective option, compared tolifestyle modification alone.12 Study 19 Authors/publish year: Warren/2004; country: UK and US; study type: CUA; setting:primary care; study perspective: payerBariatric treatments for adult obesity 192
ObjectiveTo assess the clinical impact and cost-effectiveness of sibutramine in combination withdiet and lifestyle counselling for the treatment of obesity.Population Individuals with a BMI ≥ 30 kg/m 2 .InterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesSibutramine in combination with diet and lifestyle counselling was compared with dietand lifestyle counselling alone.5 years/6% in UK and 3% in US for costs, and 1.5% in UK and 3% in US for benefits£ and US$/2000The incremental QALY relating to weight loss, diabetes, and CHD of sibutramine overplacebo was 58.9 for the UK cohort of 1000 patients and 52.91 for the US cohort of 1000patients.Costs The incremental costs were £281,791 in UK and $491,999 in the US for a cohort of 1000patients.Marginal analysisConclusionThe ICER of sibutramine over placebo was £4780 in the UK and $9299 in the US whenconsidering the costs and benefits associated with weight loss and reductions in CHD anddiabetes events.Adding sibutramine to diet and lifestyle modification was a cost-effective option in boththe UK and the US, compared to diet and lifestyle modification alone.13 Study 20 Authors/publish year: Ara/2007; country: Finland, Germany, Switzerland, and UK; studytype: CUA; setting: primary care; study perspective: payerObjectiveTo assess the clinical impact and cost-effectiveness of sibutramine in combination withdiet and lifestyle counselling for the treatment of obesity.Population Individuals with a BMI ≥ 30 kg/m 2 .InterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesCostsMarginal analysisConclusionSibutramine in combination with diet and lifestyle counselling was compared with dietand lifestyle counselling alone.5 years/3.5% in UK and 5% in Finland, Germany, and Switzerland€/2004The incremental QALYs per 1000 patients relating to weight loss, diabetes, and CHD ofsibutramine over placebo were 50.5 for Finland, 51.5 for Germany, 54.4 for Switzerland,and 59.0 for the UK.The total incremental costs per 1000 patients were €614,031 for Finland, €706,148 forGermany, €583,742 for Switzerland, and €325,183 for the UK.The ICER of sibutramine over placebo was €12,149 for Finland, €13,707 for Germany,€10,734 for Switzerland, and €5516 for the UK.The study suggested that adding sibutramine to diet and lifestyle modification was a costeffectiveoption and could be considered as a viable alternative alongside diet andexercise.14 Study 29 Authors/publish year: Tsai/2005; country: US; study type: CUA; setting: primary care;Bariatric treatments for adult obesity 193
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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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Table T.F.1-4: Weight loss - Surger
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Page 214 and 215: CostsMarginal analysisThe cost anal
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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Bariatric treatments for adult obesity - Institute of Health Economics

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