Bariatric treatments for adult obesity - Institute of Health Economics

The referral patterns of primary care providers might be biased by gender, age, ethnicity, insurancestatus, income, and other factors, again leading to decreased representation of those groups amongthose seeking or receiving bariatric surgery.Provision of bariatric surgery in CanadaThe number of bariatric surgeries being performed in Canada cannot meet the demand. 67,69,79 Basedon 2004 data, estimated demand for bariatric surgery exceeds access by approximately 600-fold. 67Christou recently conducted a survey of members of the Canadian Association of BariatricPhysicians and Surgeons and reported that in 2007 a total of 6783 patients were waiting for bariatricsurgery and 1313 procedures were performed. 79 The estimated average waiting time for bariatricsurgery in Canada was “just over five years” (6783/1313). The survey identified a common theme oflack of resources—mainly operating room time and post-operative beds—as contributing toprolonged waits for patients seeking bariatric surgery.According to Christou, 79 bariatric surgery is difficult to access in Canada because few resources aremade available for treating severe obesity. Some provinces do not accept severe obesity as a chronicdisease and thus do not include bariatric surgery as an insured service in their health care plans.Provinces that consider bariatric surgery to be an insured service have difficulty providing timelyaccess for various reasons.A health service impact analysis conducted recently by the Canadian Agency for Drugs andTechnologies in Health (CADTH) estimated that the number of eligible obese Canadians who mayseek bariatric surgery is between 6000 and 34,000 (and may be higher), and that 1100 to 1200procedures are performed annually. 69 These estimates are limited by a lack of information on thenumber of private bariatric surgeries.Policies and practices relating to the provision of bariatric surgery in Canada vary acrossprovinces. 69,172 Between 2004–2005 and 2008–2009 bariatric surgery was performed in BritishColumbia, Alberta, Saskatchewan, Ontario, Québec, Nova Scotia, and New Brunswick, 69,172 andalmost half the procedures were provided in Québec hospitals. 172 Procedures that are funded by eachjurisdiction vary. 69 Among provinces that do not provide bariatric surgery, some provide partial orfull funding for patients to receive procedures in other jurisdictions. In provinces that providebariatric surgery, there are waiting lists. 69Data from all bariatric surgery centres in Québec showed that the average waiting time for bariatricsurgery in that province in 2007 was just under 7 years (716 surgeries were performed in 2007 in theprovince and at end of that year, 4868 patients were awaiting bariatric surgery). 79 Québec has two ofthe largest bariatric surgery programs in Canada: the McGill University Health Centre (MUHC),which performs about 150 bariatric surgeries per year, and the Université Laval, which performsabout 250 bariatric surgeries per year. 79 Data from MUHC suggest that the average waiting time ofjust over 5 years in Canada can put patients at increased risk of premature death.In some circumstances, obese Canadians may be referred to other jurisdictions or countries (such asthe US and Mexico) for bariatric surgery (this practice is referred to as medical or surgicaltourism), 69,172,173 but the effectiveness of and complication rates for this practice are unclear. 69 Tomeet the demand for bariatric surgery, in 2005 the Agence d’évaluation des technologies et desmodes d’intervention en santé (AETMIS) in Québec and the Ontario Health Technology AdvisoryCommittee (OHTAC) recommended an increase to their respective provincial capacities. 17,174AETMIS and OHTAC recommended that all bariatric surgery programs establish strict patientBariatric treatments for adult obesity 33