Bariatric treatments for adult obesity - Institute of Health Economics

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An examination of overall obesity distributions by health zones in Alberta (also shown in Table S.1)showed that people in the Edmonton and Calgary zones have lower obesity rates (17.7% and 14.2%,respectively), than those in other health zones in the province (where rates ranged from 20% to25%). 1With reference to the relationship between obesity and obesity-related morbidity, Table S.1 showsthat those who reported having been diagnosed with obesity-related morbidity were more likely toreport being obese. Obesity rates among those with cancer, diabetes, high blood pressure, and heartdisease, were 21%, 44%, 33%, and 28%, respectively, as compared to 18%, 16%, 15%, and 17%among those without comorbidities.1 For this analysis it was assumed that the previous nine Alberta health regions (www.health.alberta.ca/services/healthregions.html,accessed 24 August 2010) were represented in the current five health zones(www.albertahealthservices.ca/1532.asp, accessed August 24, 2010) as follows: South Zone: formerly the Chinook and Palliser Health Zones Calgary Zone: formerly the Calgary Health Zone Central Zone: formerly the David Thompson and East Central Health Zones Edmonton Zone: formerly the Capital Health Zone North Zone: formerly the Aspen, Peace Country, and Northern Lights Health ZonesBariatric treatments for adult obesity – March 2012 14
Table S.1: Percentage of adult obesity by demographic, geographic, and comorbidity groups in Alberta in 2007By gender Male Female Overall% 19.45% 15.88% 17.69%By education Less than HS HS Overall% 22.47% 17.15% 17.69%By marriageMarried orcommon lawWidowed Single Overall% 19.4% 19.2% 12.4% 17.7%By income (per $1,000) < 20 20–39 40–59 60–79 > 80 Overall% 16.43% 17.73% 16.78% 19.22% 21.63% 17.69%By health zone South zone Calgary zone Central zone Edmonton zone North zone Overall% 20.08% 14.24% 20.30% 17.70% 24.97% 17.69%By age (years) 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 + Overall% 8.13% 16.53% 17.89% 20.79% 23.49% 18.73% 17.69%By comorbidityCancer WO/cancer W/cancer Overall% 17.62% 20.86% 17.67%Diabetes WO/diabetes W/diabetes Overall% 16.26% 43.93% 17.66%HBP WO/HBP W/HBP Overall% 14.83% 32.53% 17.65%HD WO/HD W/HD Overall% 17.31% 27.57% 17.66%Abbreviations: HBP = high blood pressure; HD = heart disease; HS = High school; W = with; WO = withoutSource: Based on Statistics Canada 2009 Canadian Community Health Survey, Cycle 4.1, 2007–2008 (public use microdata file) [cd-rom]. Statistics Canada (producer). All computations,use, and interpretation of these data are entirely those of the authors of this STE report.Bariatric treatments for adult obesity 15
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 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
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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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Page 222 and 223:
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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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Bariatric treatments for adult obesity - Institute of Health Economics

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