The safety, effectiveness and cost-effectiveness of surgical and non-surgical interventions for patients with morbid obesity

Stephenson M, Hogan S
Record ID 32007000914
English
Authors' objectives: This technical brief provides an update on the literature examining the safety, effectiveness and cost effectiveness of surgical and non-surgical interventions for patients with morbid obesity (BMI ≥ 40 or ≥ 35 with serious obesity-related comorbidities). A previous NZHTA technical brief (Day 2005) reviewed reports published up to 2004 and the current report aimed to summarise the literature published subsequent to that report. Recent primary studies were included where the secondary evidence was lacking. Of interest were studies focussing on the effectiveness, safety and cost effectiveness of surgical interventions in comparison with non-surgical (diet, exercise, psychological, pharmacological) interventions, and studies or reviews comparing the relative effectiveness and cost effectiveness of different surgical procedures. Where possible, information was included regarding the safety of different interventions, including long-term and short-term complications, and the effect of interventions on obesity-related comorbid conditions.
Authors' recommendations: Overall, bariatric surgery appears to be a more clinically effective and a more cost effective treatment option for patients with morbid obesity compared with non-surgical treatments. Surgical intervention results in significantly greater weight loss and this in turn leads to the improvement and often resolution of obesity-related comorbid conditions. Less clear is the relative clinical effectiveness of different surgical procedures, mainly due to a lack of randomised controlled trials with long-term follow-up of an adequate proportion of patients. The cost effectiveness literature is also limited and does not allow for the recommendation of one surgical procedure over another. Many reviews suggest that the choice and success of bariatric procedures should depend largely on patient characteristics, such as baseline BMI, comorbidities, food habits and psychological differences, as well as patient and surgeon preference. Current research is focusing on the identification of the best treatment options for patients with differing risk profiles and characteristics but there is still a need for well-controlled long-term trials to ascertain which procedures may be the most appropriate and most effective for different patient groups.
Details
Project Status: Completed
Year Published: 2007
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: New Zealand
MeSH Terms
  • Treatment Outcome
  • Weight Loss
  • Obesity, Morbid
Contact
Organisation Name: New Zealand Health Technology Assessment
Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;
Contact Name: nzhta@chmeds.ac.nz
Contact Email: nzhta@chmeds.ac.nz
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.