Bariatric treatments for adult obesity - Institute of Health Economics

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the need for regular physical activity, and how to better regulate the lifestyle habits that need to bemodified. According to best practice recommendations, an effective weight management programrequires a specially adapted treatment structure offering:a range of bariatric treatments targeted at the various subgroups of the population;the availability of a multidisciplinary team; a specialized technical and equipment capacity.Long-term, if not lifelong, follow-up and continued supervision and support are necessary toprevent weight regain, monitor disease risks, and treat co-morbidities. Implementation of effectiveweight management programs should also include a continuous improvement approach integratingongoing audit and evaluation.To improve adherence to bariatric treatments and to enhance the success of long-term weightmanagement, patient-, provider-, and system-level barriers to effective weight control should beidentified and addressed. Patients’ readiness and motivation to make the necessary lifestyle changesare critical. Professional support and involvement are also necessary for sustained lifestyle andbehavioural changes to take place. An environment free of bias toward obesity is an importantrequirement in providing quality of care for individuals with obesity. The quality of bariatric carealso depends on healthcare professionals receiving appropriate training and accreditation and havingan awareness of available local resources. Although long-term multidisciplinary care and follow-upunderlies the best practice, it may present certain barriers to the implementation of evidence-basedweight management programs because of the lack of resources to support such programs within thecurrent environment of cost containment, and the lack of widespread insurance coverage for weightmanagement.The disease management and chronic care models may provide helpful templates for redesigningclinical practice in adult obesity management and for helping to overcome some of the barriers toeffective weight management. According to the reviewed literature, the most effective weightmanagement programs adopted a comprehensive disease management/chronic care approach thatcombines health promotion at the population level with clinical interventions and support. Thedevelopment of a multi-level obesity management network of mutually collaborating facilitiesinvolving primary care physicians, specialists in bariatric care, other specialists, and support groups isencouraged as a sensible response to the current demand for action.Bariatric treatments for adult obesity 40
Appendix S.A: Search Strategy for Social Systems and Demographics(S) Approach to AnalysisLiz Dennett, MLISThe IHE Research Librarian conducted the literature search for publications published between2005 and 1 May 2010. The search was further limited to human studies and to publication types.The search was developed and carried out prior to the study selection process. In addition to thestrategy outlined below (which was conducted between April 14 and June 4, 2010), reference lists ofretrieved articles were reviewed for potentially relevant articles.Medical Subject Headings (MeSH) terms relevant to this topic are shown in Table S.A.1.Table S.A.1: Search strategyDatabaseMEDLINE (includesin-process andnon-medline citations)OVID LicensedResourceEdition ordate searched Search Terms ††1 May 2005 –1 May 20101. *obesity/2. *obesity, morbid/3. (obes* or superobes* or weight or bariatric*).ti.4. 1 or 2 or 35. limit 4 to english language6. limit 5 to yr="2005 - 2010"7. limit 6 to "all child (0 to 18 years)"8. limit 7 to "all adult (19 plus years)"9. 6 not (7 not 8)10. limit 9 to animals11. 9 not 1012. (unplanned weight or unintended weight or involuntary weight orantipsychotic or schizophreni* or bipolar or Parkinson* orAlzheimer* or smoking or dementia or bulimi* or anorexi* orurinary incontinence or ui or pelvic floor or asthma or adhd orattention-deficit or apn?ea or cancer or colorectal orgastroesophageal or fatty liver of osteoarthriti* or arthriti* orurologic* or mood disorders or birth weight or diarrhea or kidney orgallstone*).ti.13. 11 not 1214. Bariatric surgery/15. gastric bypass/16. gastroplasty/17. lipectomy/18. roux-en-y.ti.19. (bariatric surgery or LAGB or laprascopic adjustable gastric band* orlap band* or gastric balloon or intragastric balloon).ti.20. Bariatrics/21. Weight Loss/22. Anti-Obesity Agents/23. Appetite Depressants/24. diethylpropion/ or phenmetrazine/ or phentermine/ orBariatric treatments for adult obesity 41
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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 .................
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 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 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
Page 108 and 109: SurgeryDescription of the included
Page 110 and 111: follow-up time was 3 years. Results
Page 112 and 113: 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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