Rationale for Bariatric surgery:  Medical & Financial Arguments
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Rationale for Bariatric surgery: Medical & Financial Arguments

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Rationale for Bariatric surgery:  Medical & Financial Arguments Rationale for Bariatric surgery: Medical & Financial Arguments Presentation Transcript

  • Lecture at Derby Bariatric Surgery Course 14-06-2012Rationale for Bariatric Surgery:Medical & Financial Arguments Abeezar I. Sarela MSc MS MD FRCS Consultant in Upper GI & Bariatric Surgery Leeds Teaching Hospitals NHS Trust www.foregutsurgeon.com
  • Why should we be paid to do Bariatric Surgery? www.foregutsurgeon.com
  • Rationale for Bariatric Surgery Medical Financial 1. Efficacy2. Efficiency 3. Safety www.foregutsurgeon.com
  • Medical Rationale For Bariatric Surgerywww.foregutsurgeon.com
  • Weight Loss with Bariatric SurgerySjostrom L et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007;357:741-52. www.foregutsurgeon.com
  • Bariatric Surgery: What is the Evidence that it Works?• 22,094 patients• Excess weight loss – Bypass: 60-75% – Band: 55-65%• Operative mortality – Bypass: 0.5% – Band: 0.1%• Diabetes: Resolved in 77%• Hypertension: Resolved in 62%• Obstructive Sleep Apnea: Resolved in 86% Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292:1724-1737 www.foregutsurgeon.com
  • Bariatric Surgery: What is the Evidence that it Works?• USA• 1984-2002• 7925 gastric bypass patients vs. 7925 weight and risk matched controls• Significantly ↓ mortality in bypass patients – Overall mortality ↓ 40% – Coronary disease related mortality ↓ 56% – Diabetes related mortality ↓ 92% – Cancer related mortality ↓ 60% Long-Term Mortality After Gastric Bypass Surgery NEJM 2007;357:753-61 www.foregutsurgeon.com
  • Bariatric Surgery: What is the Evidence that it Works?• 11 years follow-up• Bariatric surgery 2010 patients vs. Conventional treatment 2037 patients• Weight loss – Bypass: 2 years, 32%; 10 years, 25% – Banding: 2 years, 20%; 10 years, 14%• Risk adjusted hazard ratio for death: bariatric surgery vs. conventional treatment – 0.70 Effects of Bariatric Surgery on Mortality in Swedish Obese Patients NEJM 2007;357:741-752 www.foregutsurgeon.com
  • Effects of Bariatric Surgery on Type 2 DM A Systematic Review and Meta-analysis• 621 studies: 1990-2006• 135, 246 patients• Women: 80%• Mean BMI 48 kg/m2• Resolution of T2DM : 78%• Resolution or improvement: 84% Buchwald et al. Am J Med 2009;122:248-256 www.foregutsurgeon.com
  • LexingtonStick or carrot?When it comes to obesity, Michelle Obamacan teach Michael Bloomberg somethingJun 9th 2012 | from the print edition www.foregutsurgeon.com
  • www.foregutsurgeon.com
  • Health EconomicsTreating Obesity with Bariatric Surgery www.foregutsurgeon.com
  • NIHR HTASouthampton HealthTechnology AssessmentsCentre, University ofSouthampton, UK.Health TechnologyAssessment Program wasestablished in 1993 as partof the National Institute forHealth Research.Research findings of HTAdirectly influence decision-making bodies such asNICE and DoH. www.foregutsurgeon.com
  • NIHR HTA of Bariatric Surgery• Bariatric surgery was cost-effective in comparison to non-surgical treatment in the published estimates.• Estimates are unlikely to be reliable and not generalizable because of methodological shortcoming and modeling assumptions. www.foregutsurgeon.com
  • NIHR HTA of Bariatric Surgery• Development of a new economic model• Surgical management was more costly than non-surgical management but gave improved outcomes.• Incremental cost-effectiveness ratios of £2000-£4000 per QALY gained – within the cost-effectiveness range for NHS decision- making. www.foregutsurgeon.com
  • Office of HealthEconomics www.foregutsurgeon.com
  • Shedding The Pounds www.foregutsurgeon.com
  • Shedding The Pounds www.foregutsurgeon.com
  • Conclusion• Bariatric Surgery is clinically effective and cost- effective as compared to non-surgical interventions.• Uncertainties: – QOL – Impact of surgeon experience – Late complications leading to re-operation – Duration of co-morbidity remission – Potential benefits of early intervention www.foregutsurgeon.com