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The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: background, design and rationale.

https://arctichealth.org/en/permalink/ahliterature140191
Source
BMC Health Serv Res. 2010;10:284
Publication Type
Article
Date
2010
Author
Raj S Padwal
Sumit R Majumdar
Scott Klarenbach
Dan W Birch
Shahzeer Karmali
Linda McCargar
Konrad Fassbender
Arya M Sharma
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. rpadwal@ualberta.ca
Source
BMC Health Serv Res. 2010;10:284
Date
2010
Language
English
Publication Type
Article
Keywords
Adaptation, Physiological
Adaptation, Psychological
Adult
Alberta
Bariatric Surgery - economics - methods - psychology
Body mass index
Cohort Studies
Cost of Illness
Cost-Benefit Analysis
Female
Follow-Up Studies
Health Care Costs
Humans
Male
Middle Aged
Obesity, Morbid - diagnosis - surgery
Patient Satisfaction - statistics & numerical data
Patient Selection
Postoperative Care - methods
Postoperative Complications - physiopathology
Preoperative Care - methods
Prospective Studies
Quality of Life
Risk assessment
Time Factors
Treatment Outcome
Waiting Lists
Weight Loss
Abstract
Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective) economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery.
Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada), with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference-based quality of life assessment, patient satisfaction, patient utilities, anthropometric indices, cardiovascular risk factors, health care utilization and direct and indirect costs.
The results will identify the spectrum of potential risks associated with protracted wait times for bariatric care and will quantify the economic, humanistic and clinical impact of surgery from the Canadian perspective. Such information is urgently needed by health-service providers and policy makers to better allocate use of finite resources. Furthermore, our findings should be widely-applicable to other publically-funded jurisdictions providing similar care to the extremely obese.
Clinicaltrials.gov NCT00850356.
Notes
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PubMed ID
20932316 View in PubMed
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Bariatric surgery in Canada — bridging the gap.

https://arctichealth.org/en/permalink/ahliterature132969
Source
Can J Surg. 2011 Jun;54(3):152-3
Publication Type
Article
Date
Jun-2011
Author
Chris Cobourn
Author Affiliation
Trillium Health Centre, Mississauga, Ont., Canada. chcobourn@rogers.com
Source
Can J Surg. 2011 Jun;54(3):152-3
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Bariatric Surgery - economics - methods - standards - trends
Canada
Critical Care
Gastric Bypass - economics
Humans
Patient Selection
Private Sector
Public Sector
Questionnaires - standards
Reproducibility of Results
Research Design - standards
Uncertainty
Notes
Cites: Can J Surg. 2011 Jun;54(3):154-6921609516
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Comment On: Can J Surg. 2011 Jun;54(3):154-6921609516
Erratum In: Can J Surg. 2011 Aug;54(4):226
PubMed ID
21755619 View in PubMed
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Budget impact analysis of surgical treatment for obesity in Sweden.

https://arctichealth.org/en/permalink/ahliterature120790
Source
Scand J Surg. 2012;101(3):190-7
Publication Type
Article
Date
2012
Author
S. Borg
I. Näslund
U. Persson
K. Odegaard
Author Affiliation
The Swedish Institute for Health Economics (IHE), Lund, Sweden. sb@ihe.se
Source
Scand J Surg. 2012;101(3):190-7
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Bariatric Surgery - economics
Body mass index
Budgets
Computer simulation
Female
Health Care Costs
Humans
Male
Markov Chains
Middle Aged
Models, Economic
Obesity - complications - economics - mortality - surgery
Sweden
Young Adult
Abstract
The recent substantial increase in the number of obese surgeries performed in Sweden has raised concerns about the budget impact.
Our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in Sweden.
The model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body Mass Index (BMI). Costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. The diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. Four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with BMI > 40, (3) 4 000 (BMI > 40), and (4) 5 000 (expanded to BMI > 38).
Comparing Scenario 2 with Scenario 1 results in a net budget impact of on average SEK 121 million per annum or SEK 40 000 per patient. This implies that 55 percent of the cost of surgery, set equal to SEK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. Expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from BMI > 40 to BMI > 38, no cost-offset is obtained.
A cost-minimization strategy for bariatric surgery in Sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.
PubMed ID
22968243 View in PubMed
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Characteristics of the population eligible for and receiving publicly funded bariatric surgery in Canada.

https://arctichealth.org/en/permalink/ahliterature120650
Source
Int J Equity Health. 2012;11:54
Publication Type
Article
Date
2012
Author
Raj S Padwal
Hsui-Ju Chang
Scott Klarenbach
Arya M Sharma
Sumit R Majumdar
Author Affiliation
Department of Medicine, 2F1,26 Walter C, Mackenzie Health Sciences Centre, University of Alberta, 8440-112th Street, Edmonton, T6G 2B7, Alberta, Canada. rpadwal@ualberta.ca
Source
Int J Equity Health. 2012;11:54
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery - economics - statistics & numerical data
Canada - epidemiology
Female
Health status
Health Surveys
Humans
Male
Medical Assistance - statistics & numerical data
Middle Aged
Obesity - economics - epidemiology - surgery
Prevalence
Young Adult
Abstract
Bariatric surgery is the most effective current treatment for severe obesity. Capacity to perform surgery within Canada's public health system is limited and potential candidates face protracted wait times. A better understanding of the gaps between demand for surgery and the capacity to provide it is required. The purpose of this study was to quantify and characterize the bariatric surgery-eligible population in Canada in comparison to surgery-ineligible subjects and surgical recipients.
Data from adult (age > 20) respondents of the 2007-09 nationally representative Canadian Health Measures Survey (CHMS) were analyzed to estimate the prevalence and characteristics of the surgery-eligible and ineligible populations. Federally mandated administrative healthcare data (2007-08) were used to characterize surgical recipients.
In 2007-09, an estimated 1.5 million obese Canadian adults met eligibility criteria for bariatric surgery. 19.2 million were surgery-ineligible (3.4 million obese and 15.8 million non-obese). Surgery-eligible Canadians had a mean BMI of 40.1 kg/m2 (95% CI 39.3 to 40.9 kg/m2) and, compared to the surgery-ineligible obese population, were more likely to be female (62 vs. 44%), 40-59 years old (55 vs. 48%), less educated (43 vs. 35%), in the lowest socioeconomic tertile (41 vs. 34%), and inactive (73 vs. 59%). Self-rated mental health and quality of life were lower and comorbidity was higher in surgery-eligible respondents compared with the ineligible populations. The annual proportion of Canadians eligible for surgery that actually underwent a publicly funded bariatric surgery between 2007-09 was 0.1%. Surgical recipients (n = 847) had a mean age of 43.6 years (SD 11.1) and 82% were female. With the exception of type 2 diabetes, obesity-related comorbidity prevalence was much lower in surgical recipients compared to those eligible for surgery.
The proportion of bariatric surgery-eligible Canadians that undergo publicly funded bariatric surgery is very low. There are notable differences in sociodemographic profiles and prevalence of comorbidities between surgery-eligible subjects and surgical recipients.
Notes
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PubMed ID
22984790 View in PubMed
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Comparison of public and private bariatric surgery services in Canada.

https://arctichealth.org/en/permalink/ahliterature134221
Source
Can J Surg. 2011 Jun;54(3):154-69
Publication Type
Article
Date
Jun-2011
Author
Allan R Martin
Jason Klemensberg
Laz V Klein
David Urbach
Chaim M Bell
Author Affiliation
Department of Medicine, University of Toronto, Ont., Canada.
Source
Can J Surg. 2011 Jun;54(3):154-69
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Bariatric Surgery - economics - methods
Canada
Confounding Factors (Epidemiology)
Gastric Bypass - adverse effects - economics
Health Care Costs - statistics & numerical data
Health Care Surveys
Humans
Interdisciplinary Communication
Private Sector
Public Assistance
Questionnaires
Referral and Consultation - economics - statistics & numerical data
Research Design
Telephone
Abstract
Surgical treatment of obesity is cost-effective and improves life expectancy. Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) are dominant surgical techniques, but RYGB is the only publicly insured procedure in all Canadian provinces. Private clinics currently offer AGB with minimal wait times. We sought to compare RYGB in public facilities with AGB in private clinics in terms of cost, wait times and certain aspects of patient care.
We conducted telephone interviews of all bariatric surgery providers across Canada (100% response rate). We asked about various aspects of care, such as wait time, cost, pre- and postoperative care and surgeon experience.
The median out-of-pocket cost for AGB at private facilities is $16,000 (range $13,160-$18,375). Private clinics have much shorter wait times for AGB than public facilities do for RYGB (1 v. 21 mo, p
Notes
Cites: N Engl J Med. 2009 Jul 30;361(5):445-5419641201
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Cites: Obes Surg. 2005 Apr;15(4):546-5115946436
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Comment In: Can J Surg. 2011 Jun;54(3):152-321755619
PubMed ID
21609516 View in PubMed
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The cost of bariatric medical tourism on the Canadian healthcare system.

https://arctichealth.org/en/permalink/ahliterature104354
Source
Am J Surg. 2014 May;207(5):743-6; discussion 746-7
Publication Type
Article
Date
May-2014
Author
Caroline E Sheppard
Erica L W Lester
Shahzeer Karmali
Christopher J de Gara
Daniel W Birch
Author Affiliation
Centre for the Advancement of Minimally Invasive Surgery, Room No. 502 CSC, 10240 Kingsway Avenue, Royal Alexandra Hospital, Edmonton, Alberta T5H 3V9, Canada; University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9, Canada.
Source
Am J Surg. 2014 May;207(5):743-6; discussion 746-7
Date
May-2014
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery - economics
Canada
Female
Health Care Costs - statistics & numerical data
Humans
Male
Medical Tourism - economics
Middle Aged
Postoperative Care - economics
Postoperative Complications - economics - therapy
Abstract
Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed.
Between February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return.
Conservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD.
The absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment.
PubMed ID
24791638 View in PubMed
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Cost-utility of bariatric surgery for morbid obesity in Finland.

https://arctichealth.org/en/permalink/ahliterature131682
Source
Br J Surg. 2011 Oct;98(10):1422-9
Publication Type
Article
Date
Oct-2011
Author
S. Mäklin
A. Malmivaara
M. Linna
M. Victorzon
V. Koivukangas
H. Sintonen
Author Affiliation
Finnish Office for Health Technology Assessment, National Institute for Health and Welfare, Helsinki, Finland. suvi.maklin@thl.fi
Source
Br J Surg. 2011 Oct;98(10):1422-9
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery - economics - methods
Body mass index
Cost-Benefit Analysis
Female
Finland
Humans
Male
Middle Aged
Obesity, Morbid - economics - surgery
Quality of Life
Quality-Adjusted Life Years
Weight Loss
Abstract
The aim of this study was to evaluate the cost-utility of bariatric surgery (gastric bypass, sleeve gastrectomy and gastric banding) compared with ordinary treatment in the Finnish healthcare system.
Analysis was done from a healthcare provider's perspective using a combination of a decision tree and a Markov model, with a time horizon of 10 years. Health-related quality of life was estimated from a representative population survey, and other parameter values were based on registers, systematic reviews, controlled studies and expert opinion.
In the base-case analysis, bariatric surgery was both more effective and less costly than the ordinary treatment. The mean costs were €33,870 and €50,495, and the mean number of quality-adjusted life-years 7·63 and 7·05, for bariatric surgery and ordinary treatment respectively. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses, and the results were robust.
Surgery for morbid obesity increases health-related quality of life, and reduces the need for further treatments and total healthcare costs. According to this analysis, non-operative care would be more costly for the Finnish healthcare system on average after 5 years following surgery.
Notes
Comment In: Br J Surg. 2011 Oct;98(10):143021887778
PubMed ID
21887777 View in PubMed
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[Cost-utility of bariatric surgery in the treatment for morbid obesity in Finland].

https://arctichealth.org/en/permalink/ahliterature146807
Source
Duodecim. 2009;125(20):2265-73
Publication Type
Article
Date
2009
Author
Suvi Mäklin
Antti Malmivaara
Miika Linna
Mikael Victorzon
Vesa Koivukangas
Harri Sintonen
Author Affiliation
Terveyden ja hyvinvoinnin laitos, menetelmien arviointiyksikkö Finohta.
Source
Duodecim. 2009;125(20):2265-73
Date
2009
Language
Finnish
Publication Type
Article
Keywords
Bariatric Surgery - economics
Cost-Benefit Analysis
Finland
Humans
Obesity, Morbid - economics - surgery
Abstract
Finohta's health technology assessment report on bariatric surgery included a cost-utility analysis on three main surgical interventions used in Finland. A cost-utility analysis from the health care provider's perspective with a ten year time horizon was conducted. The parameter values were based on a representative population survey, register data, literature and expert opinions. Based on the analysis, bariatric surgery is more effective and less costly than current prevailing forms of treatment for the morbidly obese in Finland. The results were robust and consistent with previously published studies: Bariatric surgery is cost-effective in treatment of morbid obesity.
PubMed ID
19998764 View in PubMed
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Effects of bariatric surgery on disability pension in Swedish obese subjects.

https://arctichealth.org/en/permalink/ahliterature136602
Source
Int J Obes (Lond). 2012 Mar;36(3):356-62
Publication Type
Article
Date
Mar-2012
Author
L. Gripeteg
A K Lindroos
M. Peltonen
L. Sjöström
K. Narbro
Author Affiliation
Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Source
Int J Obes (Lond). 2012 Mar;36(3):356-62
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery - economics - methods - statistics & numerical data
Disability Evaluation
Disabled persons - statistics & numerical data
Female
Follow-Up Studies
Humans
Incidence
Life Style
Male
Middle Aged
Obesity, Morbid - economics - epidemiology - surgery
Pensions
Prospective Studies
Risk factors
Sweden - epidemiology
Time Factors
Weight Loss
Abstract
Prospective controlled data on the long-term effects of bariatric surgery on disability pension are not available. This study prospectively compare disability pension in surgically and conventionally treated obese men and women.
The Swedish obese subjects study started in 1987 and involved 2010 obese patients who had bariatric surgery and 2037 contemporaneously matched obese controls, who received conventional treatment. Outcomes of this report were: (i) incidence of disability pension from study inclusion to 31 December 2006 in all subjects, and, (ii) number of disability pension days over 10 years in a subgroup of individuals (N=2901) followed for at least 10 years where partial pensions were recalculated to full number of days per year. Objective information on granted disability pension was obtained from the Swedish Social Insurance Agency and disability pension follow-up rate was 99.9%.
In men, the unadjusted incidence of disability pension did not differ between the surgery and control groups (N=156 in both groups). When adjusting for baseline confounders in men, a reduced risk of disability pension was suggested in the surgery group (hazard ratio 0.79, 95% confidence interval 0.62-1.00; P=0.05). Furthermore, the adjusted average number of disability pension days was lower in the surgery group, 609 versus 734 days (P=0.01). In women, bariatric surgery was not associated with significant effects on incidence or number of days of disability pension.
Bariatric surgery may be associated with favourable effects on disability pension for up to 19 years in men whereas neither favourable nor unfavourable effects could be detected in women.
PubMed ID
21364529 View in PubMed
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14 records – page 1 of 2.