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01-10-2011 | Reviews

Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

Authors: Raj Padwal, MD MSc, Scott Klarenbach, MD MSc, Natasha Wiebe, MMath PStat, Maureen Hazel, MA, Daniel Birch, MSc MD, Shahzeer Karmali, MD, Arya M. Sharma, MD PhD, Braden Manns, MD MSc, Marcello Tonelli, MD SM

Published in: Journal of General Internal Medicine | Issue 10/2011

Abstract

CONTEXT

Use of bariatric surgery for severe obesity has increased dramatically.

OBJECTIVE

To systematically review 1. the clinical efficacy and safety, 2. cost-effectiveness of bariatric surgery, and 3. the association between number of surgeries performed (surgical volume) and outcomes.

DATA SOURCES

MEDLINE (from 1950), EMBASE (from 1980), CENTRAL, EconLit, EURON EED, Harvard Center for Risk Analysis, trial registries and HTA websites were searched to January 2011.

STUDY SELECTION

1. Randomized controlled trials (RCTs) and 2. cost-utility and cost-minimisation studies comparing a contemporary bariatric surgery (i.e., adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) to another contemporary surgical comparator or a non-surgical treatment or 3. Any study reporting the association between surgical volume and outcome.

DATA EXTRACTION

Outcomes included changes in weight and obesity-related comorbidity, quality of life and mortality, surgical complications, resource utilization, and incremental cost-utility.

RESULTS

RCT data evaluating mortality and obesity-related comorbidity endpoints were lacking. A small RCT of 16 patients reported that adjustable gastric banding reduced weight by 27% (p < 0.01) compared to diet-treated controls over 40 weeks. Six small RCTs reported comparisons of commonly used, contemporary procedures. Gastric banding reduced weight to a lower extent than gastric bypass and sleeve gastrectomy and resulted in shorter operating times, fewer serious complications, lower weight loss efficacy, and more frequent reoperations compared to gastric bypass. Sleeve gastrectomy and gastric bypass reduced weight to a similar extent. A 2-year RCT in 50 adolescents reported that gastric banding substantially reduced weight compared to lifestyle modification (35 kg vs. 3 kg; p <0.001). Based on findings of 14 observational studies, higher volume centers and surgeons had lower mortality and complication rates. Surgery resulted in long-term incremental cost–utility ratios of $ <1.000–$40,000 (2009 USD) per quality-adjusted-life-year compared with non-surgical treatment.

CONCLUSIONS

Contemporary bariatric surgery appears to result in sustained weight reduction with acceptable costs but rigorous, longer-term (≥5 year) data are needed and a paucity of RCT data on mortality and obesity related comorbidity is evident. Procedure-specific variations in efficacy and risks exist and require further study to clarify the specific indications for and advantages of different procedures.

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Title: Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence
Authors: Raj Padwal, MD MSc
Scott Klarenbach, MD MSc
Natasha Wiebe, MMath PStat
Maureen Hazel, MA
Daniel Birch, MSc MD
Shahzeer Karmali, MD
Arya M. Sharma, MD PhD
Braden Manns, MD MSc
Marcello Tonelli, MD SM
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 10/2011
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-011-1721-x

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Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)

Radiation Pneumonitis

Reducing Barriers to Mental Health and Social Services for Iraq and Afghanistan Veterans: Outcomes of an Integrated Primary Care Clinic

Drug Benefit Changes Under Medicare Advantage Part D: Heterogeneous Effects on Pharmaceutical Use and Expenditures

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials