Bariatric treatments for adult obesity - Institute of Health Economics

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ResultHealth outcomesCostsMarginal analysisConclusionThe target population comprised 12 million and 0.65 million individuals in communitybasedintervention and intensive lifestyle programs, respectively.Of the target population, which comprised 12 million and 0.65 million individuals incommunity-based intervention and intensive lifestyle programs, respectively, thecombined intervention generated 110,000 LYs and 150,000 QALYs saved over 20 years,and 1.3 million LYs and 1.22 million QALYs saved over 80 years, as compared to nointervention.The total costs were presented graphically.Compared to no intervention, the ICER was €5,100 per LY gained and €5,000 per QALYgained with the community-based intervention alone, €8,400 per LY gained and €7,400per QALY gained with intensive lifestyle modification alone, and €6,000 per LY gainedand €5,700 per QALY gained with the combination of both programs.Both community-based intervention and intensive lifestyle modification were costeffectivefor preventing and reducing overweight; the former was slightly more costeffective.Bariatric treatments for adult obesity 198
APPENDIX E.BTable E.B.1 Estimate of economic burden of obesityS1Outlined regression resultsVariableOutpatient andphysician costPhysiciancostPhysicianvisitOutpatientcostOutpatientvisitsInpatientvisitsBMI 22.716*** 17.263*** 0.320*** 12.022*** 0.084*** 0.021***Age 11.682*** 10.732*** 0.192*** 10.297*** 0.026*** 0.012***Female 115.699*** 89.703*** 1.634*** 20.4 0.069 -0.005Income -24.317 -29.264* -0.373 -43.731** -0.266** -0.026High school & over -26.581 -22.935 -0.577 29.222 0.113 -0.006Ever smoked 40.332 17.909 -0.023 25.196 0.188 0.029Has physical activity -25.649 -38.907 -0.634* -72.139* -0.228 -0.001Has COPD 164.875* 236.529*** 2.820*** 173.009** 0.262 -0.134Has back problem 54.586* 56.304** 1.560*** 16.189 0.198 0.028Has high blood pressure -34.628 -17.222 -0.205 14.867 0.001 -0.039Has diabetes 71.861 83.380** 1.381** -66.891 -0.289 -0.001N 3660 3660 3660 1660 1667 311Adj R-squared 0.41 0.34 0.46 0.39 0.29 0.75Legend: * p < .05; ** p < .01; *** p < .001Note: Graph investigation and linear test showed costs/visits are linear in body mass index. So the impact of BMI on costs/visits wasassessed using linear regression, adjusted by age, gender, etc.S2Mean costs/visits per patientOutpatient and Physician Physician Outpatient Outpatient InpatientBMIphysician costs costs visit costs visits visitsUnderweight $ 872.07 $604.04 12.120 $701.26 2.571 1.163Normal weight $ 856.38 $565.05 11.764 $643.82 2.620 1.239Overweight $ 969.94 $664.62 13.602 $712.31 3.054 1.357Obese $1150.34 $813.22 16.315 $803.15 3.694 1.442Note: Mean costs/visits were predicted using results from the regression models above.S3# of residents/patients by BMIPCD andBMI # population CCHS ACCS PCD ACCS DADUnderweight 57,796 175 105 105 48 10Normal weight 1,116,229 3586 2008 2004 836 150Overweight 842,883 2994 1682 1680 796 145Obese 463,222 1883 1140 1140 576 106Note: Second column is Alberta residents, represented by the sample in the CCHS survey; third column is residents completing theCCHS survey (i.e., the sample); remaining columns are patients in the databases.CCHS = Canadian community health survey; PCD = physician claim database; ACCS = Ambulatory Care Classification System;DAD = discharge abstract databaseBariatric treatments for adult obesity 199
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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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Table T.F.3-3: Risk factors/comorbi
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Page 198 and 199: DiscussionThe objectives of the eco
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Page 202 and 203: APPENDIX E.A: LITERATURE SEARCH SUM
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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
Page 216 and 217: Time Horizon/discount rateCurrency/
Page 218 and 219: Objectivestudy perspective: society
Page 220 and 221: 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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