Bariatric treatments for adult obesity - Institute of Health Economics

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Additional Internet searches were conducted to retrieve grey literature. Reference lists of relevantarticles were also browsed to identify more studies. Search results were limited to information abouthumans, published in English. The date restriction was applied to ensure that the evidence collectedwas current and clinically relevant.The literature search focused on articles and documents providing information on the profile(definition, etiology, pathogenesis) and epidemiology (incidence and prevalence) of obesity in adults(≥ 18 years, both genders), referred to here as adult obesity. The literature search also focused onarticles and documents providing information on the psychosocial impact of adult obesity, patternsof care, types of bariatric services provided (any class/category, duration, or stage), and demand forand usage of bariatric services/treatments in Alberta and in Canada.The search strategy focused on articles that published findings from secondary research studiesreporting on:the epidemiology of adult obesity and the demand for and utilization rates of bariatrictreatments in Alberta and Canada;systematic reviews and health technology assessment studies reporting on quality of life,ethical, and social considerations in adult obesity management;evidence-based clinical practice guidelines;policy papers; overviews, clinical reviews, and/or discussion papers that were conducted or developed inNorth America (Canada and the United States).A geographic restriction was applied.As well, a search was conducted for published local data and information, from sources includingthe Canadian Institute for Health Information (CIHI), Health Canada, Statistics Canada, theSurveillance Branch of Alberta Health and Wellness, and the Institute of Health Economics’Database of Online Health Statistics.Healthcare providers from facilities/clinics/programs providing bariatric treatments in Alberta werecontacted to provide information on the local context and clinical practice.Study selectionOne reviewer (PC) conducted the initial and final study selection using selection criteria developed apriori. The initial study selection was based on titles and/or abstracts only. Excluded were articlesthat, on the basis of their abstract, clearly did not meet the inclusion criteria. The final selection wasbased on review of full text articles.The study selection process focused on secondary research studies including systematic reviews andhealth technology assessment studies, evidence-based clinical practice guidelines, policy papers,overviews, clinical reviews, and/or discussion papers on the topic of interest. Primary researchstudies and/or papers reporting on secondary analyses of research data (such as health surveys andclaims data) were included only if they provided information about adult obesity and its managementin Alberta and in Canada.Bariatric treatments for adult obesity – March 2012 2
Clinical practice guidelines (CPGs) were included if they provided definitive recommendationsspecific to the diagnosis and management of adult obesity. An article was deemed to be a CPG if itmet all the following criteria:It contained the word ‘guideline’ or ‘recommendation’ in its title or introduction, orcontained specific guidance, in the form of advice or instructions, on how to diagnoseand/or manage adults (≥ 18 years, both genders) with obesity (of any duration or stage).It was developed by at least two authors.It used an evidence-based approach in the process of developing the guidance(recommendations, advice, or instructions were based on a systematic review of theliterature, were graded based on the strength of the supporting evidence, and reflected theconsensus of the experts involved in the development of the guidance). It described the evidence-based approach used for the development of recommendations,advice, or instructions.Only those publicly available, evidence-based CPGs developed by national bodies in Canada andother countries with developed market economies were considered.Consensus statements and/or position statements containing recommendations based solely onexpert opinion were included only if they were developed in Alberta.SOCIAL SYSTEMS AND DEMOGRAPHICS APPROACHThe social systems and demographics approach analysis summarizes available key information onthe use of bariatric treatments for adult obesity in Alberta and North America (mainly Canada). Thisanalysis was intended to describe the profile of adult obesity (definition, progression, epidemiology,and population dynamics of affected individuals in Alberta and in Canada) and patterns of care forthis condition (focusing on bariatric treatments recommended by evidence-based clinical practiceguidelines), as well as to identify potential inequities in health status or care across population groups.Also considered were social factors associated with the use of multidisciplinary programs involvingbariatric treatments for adult obesity in Alberta.Profile of IllnessAs a medical term, the term “obesity” describes a condition of excess body fat caused by animbalance between the amount of energy entering the body and the amount of energy leaving it.Obesity is the result of complex interactions between various factors including environmental (social,economic, and cultural), behavioural, hormonal, and genetic factors. It is a health problem, becauseit is associated with multiple health risks and organ-specific consequences, including type 2 diabetesmellitus (T2DM), cardiovascular disease, musculoskeletal problems, and certain forms of cancer.Over the past 30 years obesity has become one of the most prevalent conditions in countries withdeveloped market economies, and it is increasingly viewed as a societal issue (www.iotf.org, accessed23 July 2010; www.who.int/mediacentre/factsheets/fs311/en/index.html, accessed 23 July 2010). 1-15It affects individuals of all ages (children, adolescents, and adults) and both genders. It is recognizedas a major public health problem and has been identified as an epidemic by the World HealthOrganization (WHO) and medical organizations around the globe.Bariatric treatments for adult obesity – March 2012 3
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 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
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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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Table T.F.3-5: Long-term effects of
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Maciejewski et al., 2005 65Avenell
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Table T.G.2: Effects of bariatric s
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Table T.G.4: Effects of bariatric s
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18. Cerulli J, Lomaestro BM, Malone
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50. Health Canada Drug Product Data
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SECTION THREE: ECONOMIC EVALUATIONC
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Definition of bariatric surgical pa
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etween surgical interventions, the
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concluded that adding orlistat to L
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Weight management program (WMP) ver
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groups. Compared with standard care
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Results from Analysis of Provincial
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DiscussionThe objectives of the eco
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surgical suites, and so on. The bud
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APPENDIX E.A: LITERATURE SEARCH SUM
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CRD Databases(DARE, HTA & NHS EED)h
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Web of ScienceISI Interface License
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NEOS Librarywww.library.ualberta.ca
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Table E.A.2: Evidence table of revi
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ResultHealth outcomesCostsMarginal
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CostsMarginal analysisThe cost anal
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Time Horizon/discount rateCurrency/
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Objectivestudy perspective: society
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S4Economic burden of obesityMean co
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15. Lacey LA, Wolf A, O'shea D, Ern
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Author Contribution StatementsPaula
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