Evaluation of medical and health economic effectiveness of bariatric surgery ( XXXX surgery) versus conservative strategies in adult @entity1 with morbid @entity28 .

@entity2175 @entity1 @entity353 @entity28 @entity6 @entity74
BACKGROUND: Obesity with its associated medical, psychological, social, and economic complications is considered a chronic, @entity74 . Given the magnitude of the challenge @entity28 , there is a clear need for preventive as well as therapeutic measures and strategies on an individual and a public health level. OBJECTIVES: The goal of this health technology assessment (HTA)-report is to summarise the current literature on bariatric surgery, to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications of these procedures in comparison to conventional therapies and compared to each other. METHODS: Relevant publications are identified by means of a structured search of databases accessed on 13.11.2006 and an update conducted on 12.11.2007. In addition, a manual search of identified reference lists is conducted. The present report includes German and English literature published since 2001 and targeting adult subjects with morbid @entity28 (body mass index (BMI) >=40 kg/m   or BMI >=35 kg/m   with severe comorbidities). The methodological quality of studies included is assessed according to pre-defined quality criteria by two independent scientists. RESULTS: Among 5910 retrieved publications, 25 medical articles, as well as seven health economic studies meet the inclusion criteria. The medical studies show a superior @entity353 following bariatric surgery compared to conventional therapy. Malabsorptive procedures lead to a more profound @entity353 than purely restrictive procedures. Weight reduction in general is accompanied by a reduced frequency of comorbidities (mostly @entity2175 ). The evidence is not sufficient to quantify these effects for individual procedures or to assess long-term outcomes. However, recent studies show a profound survival benefit for surgically treated @entity1 up to a period of eleven years. The economic studies illustrate that bariatric surgery is cost-effective compared to no treatment or conservative treatment. The comparison between surgical therapies does not allow to draw any conclusions on cost-effectiveness. Appropriate studies/surveys, which are concerned with ethical, legal and social aspects, are not available. DISCUSSION: Concerning clinical outcomes as well as cost-effectiveness, there is a lack of high quality studies. Clinical effectiveness and safety as well as cost-effectiveness of bariatric procedures in the short- and medium-term course are agreed on, but long-term evaluations that focus not exclusively on @entity353 , but also on comorbidities and @entity1 relevant outcomes such as quality of life, are needed. Also within the economic views are missing long-term evaluation particularly for the German health care system. CONCLUSION: Based upon the available literature the short- and medium-term effectiveness of bariatric procedures on @entity353 , comorbidities, e. g. @entity6 , and mortality can be assumed and also seems to be cost-effective. No recommendation can be given with respect to the choice of a certain bariatric procedure or to the selection of particular groups of @entity1 .
