Bariatric treatments for adult obesity - Institute of Health Economics

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ResultHealth outcomesCostsMarginal analysisThe intervention was associated with a decrease of 4.4 kg in weight and 6.2 mmHg insystolic blood pressure, as compared to the control.Costs of weight-wise intervention were $242 per person. Control group was assumed tobe with zero cost.The ICER was $1862 per LY gained.ConclusionThe weight-wise intervention was a cost-effective approach.18 Study 26 Authors/publish year: Gusi/2008; country: Spain; study type: CUA; setting: primary care;study perspective: healthcare systemObjectivePopulationInterventionTime Horizon/discount rateCurrency/priceyearResultHealth outcomesTo assess the cost-effectiveness of a walking program compared to best care.Women aged ≥ 60 years with a BMI between 25 kg/m 2 and 39.9 kg/m 2 or 6 to 9 pointsin the 15-item Geriatric Depression Scale.The walking program consisted of walks with a group in public park or forest tracks,guided by the qualified exercise leaders, for 50 minutes, three times per week over 6months. The individuals in best care group received routine care and a physical activityrecommendation.6 months/na€/2005The mean QALY was 0.395 and 0.263 in intervention versus control group, with anincremental QALY of 0.132.Costs The mean incremental cost per person in the intervention over control group was €41.Marginal analysisThe ICER was €311 per QALY gained.ConclusionThe walking program was cost-effective for depressed or overweight elderly women,compared to best care.19 Study 31 Authors/publish year: Galani/2007; country: Switzerland; study type: CEA, CUA; setting:primary care; study perspective: societyObjectivePopulationInterventionTo assess the lifetime health and economic impact of a lifestyle intervention forpreventing and treating obesity, as compared to standard care.Individuals aged ≥ 25 years with a BMI between 25 kg/m 2 and 35 kg/m 2 . The populationwas assessed in three sub-groups based on BMI: overweight with a BMI 25 kg/m 2 to 29.9kg/m 2 , moderately obese with a BMI 30 kg/m 2 to 35 kg/m 2 , and bordline with a BMI 30kg/m 2 .Individuals in lifestyle intervention group attended dietician and supervised exercisesessions during the first 3 years. The intervention consisted of recommendations to limittotal intake of fat to less than 30% of energy consumption and of saturated fat to lessthan 10%, to increase fibre to at least 15g/1000kcal, and to undertake moderate dailyexercise for at least 30 minutes. The dietician also advised about food types. Standard careconsisted of basic dietary counselling and physical exercise sessions for obese patients andof no intervention for overweight patients.Bariatric treatments for adult obesity 196
Time Horizon/discount rateCurrency/priceyearLifetime/3%Swiss Francs (CHF)/2006ResultHealth outcomesThe lifestyle intervention over the standard care in overweight, borderline, andmoderately obese patients was associated with 0.01 LY gained for both men and women.The lifestyle intervention over standard care was associated with QALY gained of 0.23 inoverweight women and 0.25 in overweight men, 0.25 in borderline women and 0.28 inborderline men, and 0.26 in moderately obese women and 0.29 in moderately obese men.CostsMarginal analysisConclusionThe incremental costs of the lifestyle intervention over standard care were CHF 510 inoverweight women and CHF 405 in overweight men, CHF 80 in borderline women andCHF 6 in borderline men, and CHF 207 in moderately obese women and CHF 127 inmoderately obese men.Results of the marginal analysis were reported by age/sex groups.For overweight patients, the ICER was from CHF 17,149 in 55-year-old men to CHF295,863 in 25-year-old women per LY gained, and from CHF 914 in 55-year-old men toCHF 6286 in 25-year-old women per QALY gained.For moderately obese patients, the ICER was from dominant (due to more effective andless costly) in 45-year-old and 55-year-old men to CHF 171,544 in 25-year-old women perLY gained, and from dominant in 35-year-old women and 55-year-old men to CHF 3180in 25-year-old women per QALY gained.For borderline patients, the ICER was from dominant in all male age groups to CHF142,619 per LY gained in 25-year-old women, and from dominant in all male age groupsto CHF 3,023 per QALY gained in 25-year-old women.The lifestyle interventions were cost-effective in long-run.20 Study 27 Authors/publish year: Bemelmans/2008; country: Netherlands; study type: CEA, CUA;setting: community; study perspective: healthcare systemObjectiveTo evaluate the clinical and economic impact of a community intervention and anintensive lifestyle program for prevention of overweight.Population Individuals with a BMI ≥ 25 kg/m 2InterventionTime Horizon/discount rateCurrency/priceyearCommunity-based intervention and intensive lifestyle modification were evaluated incomparison with no intervention. The community-based intervention offered socialsupport such as self-help groups, risk factor screening, and/or counselling to 90% of thegeneral population, while the intensive lifestyle modification was offered to 10% of thepopulation and targeted at overweight individuals.20 years and 80 years/4%€/2004Bariatric treatments for adult obesity 197
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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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Table T.F.2: Quality of life (QoL)
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Curioni & Lourenco 2005 58Cholester
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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 214 and 215: CostsMarginal analysisThe cost anal
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Page 218 and 219: Objectivestudy perspective: society
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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