A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity: What is cost effective and what are the implications for the Design of health Services?

Elisabet Jacobsen; Dwayne Boyers; Paul Manson; Alison Avenell

doi:10.1007/s13679-022-00483-z

A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity: What is cost effective and what are the implications for the Design of health Services?

Elisabet Jacobsen^* (Corresponding Author), Dwayne Boyers^* (Corresponding Author), Paul Manson, Alison Avenell

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose of Review
Severe obesity (BMI ≥ 35 kg/m2) increases premature mortality and reduces quality-of-life. Obesity-related disease (ORD) places substantial burden on health systems. This review summarises the cost-effectiveness evidence for non-surgical weight management programmes (WMPs) for adults with severe obesity.

Recent Findings
Whilst evidence shows bariatric surgery is often cost-effective, there is no clear consensus on the cost-effectiveness of non-surgical WMPs.

Summary
Thirty-two studies were included. Most were short-term evaluations that did not capture the long-term costs and consequences of ORD. Decision models often included only a subset of relevant ORDs, and made varying assumptions about the rate of weight regain over time. A lack of sensitivity analyses limited interpretation of results. Heterogeneity in the definition of WMPs and usual care prevents formal evidence synthesis. We were unable to establish the most cost-effective WMPs. Addressing these limitations may help future studies provide more robust cost-effectiveness evidence for decision makers.

Original language	English
Pages (from-to)	356-385
Number of pages	30
Journal	Current Obesity Reports
Volume	11
Issue number	4
Early online date	21 Nov 2022
DOIs	https://doi.org/10.1007/s13679-022-00483-z
Publication status	Published - 1 Dec 2022

Keywords

Severe obesity
Weight management programmes
Systematic review
Cost-Effectiveness

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity : What is cost effective and what are the implications for the Design of health Services? / Jacobsen, Elisabet (Corresponding Author); Boyers, Dwayne (Corresponding Author); Manson, Paul et al.

In: Current Obesity Reports, Vol. 11, No. 4, 01.12.2022, p. 356-385.

Research output: Contribution to journal › Article › peer-review

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title = "A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity: What is cost effective and what are the implications for the Design of health Services?",

abstract = "Purpose of ReviewSevere obesity (BMI ≥ 35 kg/m2) increases premature mortality and reduces quality-of-life. Obesity-related disease (ORD) places substantial burden on health systems. This review summarises the cost-effectiveness evidence for non-surgical weight management programmes (WMPs) for adults with severe obesity.Recent FindingsWhilst evidence shows bariatric surgery is often cost-effective, there is no clear consensus on the cost-effectiveness of non-surgical WMPs.SummaryThirty-two studies were included. Most were short-term evaluations that did not capture the long-term costs and consequences of ORD. Decision models often included only a subset of relevant ORDs, and made varying assumptions about the rate of weight regain over time. A lack of sensitivity analyses limited interpretation of results. Heterogeneity in the definition of WMPs and usual care prevents formal evidence synthesis. We were unable to establish the most cost-effective WMPs. Addressing these limitations may help future studies provide more robust cost-effectiveness evidence for decision makers.",

keywords = "Severe obesity, Weight management programmes, Systematic review, Cost-Effectiveness",

author = "Elisabet Jacobsen and Dwayne Boyers and Paul Manson and Alison Avenell",

note = "Acknowledgements The REBALANCE team: REBALANCE Project management team were Elisabet Jacobsen (Health Economics Research Unit, University of Aberdeen, Aberdeen, UK), Dwayne Boyers (Health Economics Research Unit, University of Aberdeen, Aberdeen, UK), David Cooper (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Lise Retat (UK Health Forum +), Paul Aveyard (Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK), Fiona Stewart (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Graeme MacLennan (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Laura Webber (UK Health Forum +) Emily Corbould (UK Health Forum), Benshuai Xu (UK Health Forum), Abbygail Jaccard (UK Health Forum), Bonnie Boyle (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Eilidh Duncan (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Michal Shimonovich (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Cynthia Fraser (Health Services Research Unit, University of Aberdeen, Aberdeen, UK) and Lara Kemp (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Zoe Skea (Health Services Research Unit, University of Aberdeen, UK), Clare Robertson (Health Services Research Unit, University of Aberdeen, UK), Magaly Aceves-Martins (Health Services Research Unit, University of Aberdeen, UK), Alison Avenell (Health Services Research Unit, University of Aberdeen, UK), Marijn de Bruin (Radboud University Medical Center, IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands). We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw and Su Sethi. +Current address HealthLumen, London. Funding This is a substantial update to the systematic review of economic evaluations that was conducted as part of our REBALANCE project. The REBALANCE project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health, or the funders that provide institutional support for the authors of that report. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.",

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T1 - A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity

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AU - Boyers, Dwayne

AU - Manson, Paul

AU - Avenell, Alison

N1 - Acknowledgements The REBALANCE team: REBALANCE Project management team were Elisabet Jacobsen (Health Economics Research Unit, University of Aberdeen, Aberdeen, UK), Dwayne Boyers (Health Economics Research Unit, University of Aberdeen, Aberdeen, UK), David Cooper (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Lise Retat (UK Health Forum +), Paul Aveyard (Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK), Fiona Stewart (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Graeme MacLennan (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Laura Webber (UK Health Forum +) Emily Corbould (UK Health Forum), Benshuai Xu (UK Health Forum), Abbygail Jaccard (UK Health Forum), Bonnie Boyle (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Eilidh Duncan (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Michal Shimonovich (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Cynthia Fraser (Health Services Research Unit, University of Aberdeen, Aberdeen, UK) and Lara Kemp (Health Services Research Unit, University of Aberdeen, Aberdeen, UK), Zoe Skea (Health Services Research Unit, University of Aberdeen, UK), Clare Robertson (Health Services Research Unit, University of Aberdeen, UK), Magaly Aceves-Martins (Health Services Research Unit, University of Aberdeen, UK), Alison Avenell (Health Services Research Unit, University of Aberdeen, UK), Marijn de Bruin (Radboud University Medical Center, IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, The Netherlands). We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw and Su Sethi. +Current address HealthLumen, London. Funding This is a substantial update to the systematic review of economic evaluations that was conducted as part of our REBALANCE project. The REBALANCE project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health, or the funders that provide institutional support for the authors of that report. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Purpose of ReviewSevere obesity (BMI ≥ 35 kg/m2) increases premature mortality and reduces quality-of-life. Obesity-related disease (ORD) places substantial burden on health systems. This review summarises the cost-effectiveness evidence for non-surgical weight management programmes (WMPs) for adults with severe obesity.Recent FindingsWhilst evidence shows bariatric surgery is often cost-effective, there is no clear consensus on the cost-effectiveness of non-surgical WMPs.SummaryThirty-two studies were included. Most were short-term evaluations that did not capture the long-term costs and consequences of ORD. Decision models often included only a subset of relevant ORDs, and made varying assumptions about the rate of weight regain over time. A lack of sensitivity analyses limited interpretation of results. Heterogeneity in the definition of WMPs and usual care prevents formal evidence synthesis. We were unable to establish the most cost-effective WMPs. Addressing these limitations may help future studies provide more robust cost-effectiveness evidence for decision makers.

AB - Purpose of ReviewSevere obesity (BMI ≥ 35 kg/m2) increases premature mortality and reduces quality-of-life. Obesity-related disease (ORD) places substantial burden on health systems. This review summarises the cost-effectiveness evidence for non-surgical weight management programmes (WMPs) for adults with severe obesity.Recent FindingsWhilst evidence shows bariatric surgery is often cost-effective, there is no clear consensus on the cost-effectiveness of non-surgical WMPs.SummaryThirty-two studies were included. Most were short-term evaluations that did not capture the long-term costs and consequences of ORD. Decision models often included only a subset of relevant ORDs, and made varying assumptions about the rate of weight regain over time. A lack of sensitivity analyses limited interpretation of results. Heterogeneity in the definition of WMPs and usual care prevents formal evidence synthesis. We were unable to establish the most cost-effective WMPs. Addressing these limitations may help future studies provide more robust cost-effectiveness evidence for decision makers.

KW - Severe obesity

KW - Weight management programmes

KW - Systematic review

KW - Cost-Effectiveness

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JO - Current Obesity Reports

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ER -

A Systematic Review of the evidence for Non-surgical weight management for adults with severe obesity: What is cost effective and what are the implications for the Design of health Services?

Abstract

Keywords

UN SDGs

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