Lecture at Derby Bariatric Surgery Course                     14-06-2012Rationale for Bariatric Surgery:Medical & Financia...
Why should we be paid to do     Bariatric Surgery?        www.foregutsurgeon.com
Rationale for Bariatric Surgery  Medical                             Financial 1. Efficacy2. Efficiency 3. Safety         ...
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...
Bariatric Surgery:       What is the Evidence that it Works?• 22,094 patients• Excess weight loss   – Bypass: 60-75%   – B...
Bariatric Surgery:      What is the Evidence that it Works?• USA• 1984-2002• 7925 gastric bypass patients vs. 7925 weight ...
Bariatric Surgery:      What is the Evidence that it Works?• 11 years follow-up• Bariatric surgery 2010 patients vs.  Conv...
Effects of Bariatric Surgery on Type 2 DM    A Systematic Review and Meta-analysis• 621 studies: 1990-2006• 135, 246 patie...
LexingtonStick or carrot?When it comes to obesity, Michelle Obamacan teach Michael Bloomberg somethingJun 9th 2012 | from ...
www.foregutsurgeon.com
Health EconomicsTreating Obesity with Bariatric Surgery              www.foregutsurgeon.com
NIHR HTASouthampton HealthTechnology AssessmentsCentre, University ofSouthampton, UK.Health TechnologyAssessment Program w...
NIHR HTA of Bariatric Surgery• Bariatric surgery was cost-effective in  comparison to non-surgical treatment in the  publi...
NIHR HTA of Bariatric Surgery• Development of a new economic model• Surgical management was more costly than  non-surgical...
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.• Un...
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Rationale for Bariatric surgery: Medical & Financial Arguments

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Rationale for Bariatric surgery: Medical & Financial Arguments

  1. 1. 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
  2. 2. Why should we be paid to do Bariatric Surgery? www.foregutsurgeon.com
  3. 3. Rationale for Bariatric Surgery Medical Financial 1. Efficacy2. Efficiency 3. Safety www.foregutsurgeon.com
  4. 4. Medical Rationale For Bariatric Surgerywww.foregutsurgeon.com
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. LexingtonStick or carrot?When it comes to obesity, Michelle Obamacan teach Michael Bloomberg somethingJun 9th 2012 | from the print edition www.foregutsurgeon.com
  11. 11. www.foregutsurgeon.com
  12. 12. Health EconomicsTreating Obesity with Bariatric Surgery www.foregutsurgeon.com
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. Office of HealthEconomics www.foregutsurgeon.com
  17. 17. Shedding The Pounds www.foregutsurgeon.com
  18. 18. Shedding The Pounds www.foregutsurgeon.com
  19. 19. 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

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