Bariatric treatments for adult obesity - Institute of Health Economics

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selection criteria, have facilities and equipment adapted to the specific profile of the suitablecandidates, have an experienced multidisciplinary team capable of supplying the full range of careand services tied to this type of bariatric treatment, provide closely monitored lifelong follow-up,and cover the physical and psychological dimensions of this treatment. AETMIS also recommendedthat a Québec registry on severe obesity and its management be established.The policy on bariatric surgery for severe obesity developed by the Québec’s Association of GeneralSurgeons (QAGS) also emphasizes the need for multidisciplinary care, designation of referral centres,information and training for surgical residents, and increased bariatric surgery trainingopportunities. 17 Furthermore, in any bariatric surgery management plan it would be advisable toanticipate the potential need for future reconstructive plastic surgery.According to the CADTH report, it is unclear to what extent additional capacity and infrastructurewould be needed in order to increase access to bariatric surgery. 69 If capacity is to be increased, itmay be reasonable to create centres of excellence for bariatric surgery that may serve a larger region.Alternative models may include providing a higher volume outside centres of excellence for lesscomplex cases. Pre- and post-surgical management could be dispersed in centres with adequatehealthcare-professional training.Provision of bariatric surgery in AlbertaUsing data from the Discharge Abstract Database of the Canadian Institute for Health Information(CIHI), CADTH estimated that 68,324 Albertans had a BMI of 40 kg/m 2 or more, or a BMI of 35kg/m 2 or more with comorbidity in 2007. 69 Assuming that between 1% and 5% would undergobariatric surgery offered, it was anticipated that between 683 and 3416 Albertans would seek surgery.Only 207 procedures were performed in 2007 in Alberta.An overview of changes in in-patient bariatric surgery delivery in Canada between 2004–2005 and2008–2009 (using data from CIHI’s Hospital Morbidity Database and Discharge Abstract Database)indicates that during this period at least 361 Canadians had bariatric surgery outside of their homeprovince/territory. 172 Twenty-five of them were from Alberta (five received bariatric surgery inSaskatchewan, seven in Ontario, and 13 in British Columbia). The data also indicate that Alberta hadthe largest inflow of out-of-province patients (N=177) over the 5-year period. Most patients werefrom Manitoba (N=87) and the Northwest Territories (N=14), where bariatric surgery was notprovided. Alberta also provided bariatric surgery for patients from Saskatchewan (N=46) and BritishColumbia (N=30), where bariatric surgery was available.An examination of 2006 data from the Alberta Discharge Abstract Database indicates that 34 outof-provincepatients received bariatric surgery procedures in Alberta in 2006 (see Table S.5).Table S.5: Number of bariatric surgical procedures provided to out-of-province patientsin 2006Province/TerritoryNumberManitoba 20Saskatchewan 3British Columbia 7Nunavut and Northwest Territories 2Yukon 2Total 34Bariatric treatments for adult obesity 34
As of January 2008, in the Weight Wise Program—which is a regional population-based medical andsurgical weight management program in Alberta—2470 patients were waiting for a clinicappointment for an initial assessment. 67 According to Padwal and Sharma, that represented a waitingtime of 4.3 years.Management of Adult Obesity in AlbertaThe literature search did not reveal any published reports about the current practice of managingadult obesity in Alberta and/or about issues related to the provision of appropriate non-surgical andsurgical bariatric treatments for this indication in Alberta. None of the retrieved articles identifiedpatient-, provider-, and system-level barriers to the effective management of adult obesity in Albertaor evaluated whether/how they impact care for obese adults in Alberta.Healthcare providers from weight management programs in Alberta were contacted by email andtelephone for a description of their programs and for information about the bariatric treatmentoptions available for adult obesity in the province. They were also asked questions regarding thedemand for and usage of non-surgical and surgical bariatric treatments for adult obesity, issuesrelated to access to and barriers to using appropriate bariatric treatments for different obesity classes,training of healthcare providers, and the current number of trained/certified healthcare providersand support staff who provide bariatric services for different obesity classes in Alberta.The following commentary summarizes the information gathered from the replies received by emailand telephone surveys, as well as from the Alberta Health Services website(www.albertahealthservices.ca) and from handouts obtained during a tour of the Weight Wise AdultWeight Management Clinic in Edmonton.Current options and standard procedure used for adult obesity managementIn Alberta, adults with obesity are selected for non-surgical and surgical bariatric care based on BMIclassification of obesity.Non-surgical bariatric treatment options that are available in Alberta include education andcounseling for nutrition and physical activity, psychological therapy (including behaviouralmodification techniques and counseling for mental health), and pharmacotherapy (it is not clear whichof the available weight management medications are more frequently used).Bariatric surgery procedures currently performed in Alberta include: laparoscopic adjustable gastricbanding, laparoscopic sleeve gastrectomy, open and laparoscopic gastric bypass, and revisionsurgeries (including Stomphyx).Demand for, access to, and utilization of bariatric treatmentsThe demand for bariatric treatments (non-surgical and surgical) to manage adult obesity in Alberta iscurrently unknown, but all obese adults searching for bariatric care in the province can beconsidered candidates. Obese adults must be referred by their family physician to be considered byone of the bariatric surgery centres. The waiting times for surgical treatments are measureddifferently by the different centres, but from referral to completion of surgery, a patient can expectthe process to take between 2 and 5 years.Access to other non-surgical weight management programs that are offered by healthcareprofessionals varies by the program, but the waiting time for initial consultation can be as short as acouple of days.Bariatric treatments for adult obesity 35
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Alberta STE ReportBariatric treatme
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Alberta STE ReportBariatric treatme
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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 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 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
Page 88 and 89: dietary therapy is to reduce total
Page 90 and 91: Additional benefits of exercise ove
Page 92 and 93: medications that inhibit intestinal
Page 94 and 95: Rimonabant may be considered for pa
Page 96 and 97: Long-term complications are specifi
Page 98 and 99: Devices used for bariatric surgeryH
Page 100 and 101: Description of the Included Systema
Page 102 and 103: AEs for sibutramineAs compared to a
Page 104 and 105: Evidence on Efficacy/EffectivenessW
Page 106 and 107: 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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Bariatric treatments for adult obesity - Institute of Health Economics

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