Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity : a decision analysis model

Acknowledgements 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, Su Sethi. +Current address HealthLumen, London. The REBALANCE team Elisabet Jacobsen1, Dwayne Boyers1, David Cooper3, Lise Retat2, Paul Aveyard4, Fiona Stewart3, Graeme MacLennan3, Laura Webber2, Emily Corbould2, Benshuai Xu2, Abbygail Jaccard2, Bonnie Boyle3, Eilidh Duncan3, Michal Shimonovich3, Cynthia Fraser3, Lara Kemp3, Clare Robertson3, Zoë Skea3, Marijn de Bruin6, Alison Avenell3 Funding The 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 Health Economics and Health Services Research Units at the University of Aberdeen are core funded by the Chief Scientists Office (CSO) of the Scottish Government Health and Social Care Directorate. Correction | Open Access | Published: 26 August 2021 Correction: Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. D. Boyers, L. Retat, E. Jacobsen, A. Avenell, P. Aveyard, E. Corbould, A. Jaccard, D. Cooper, C. Robertson, M. Aceves-Martins, B. Xu, Z. Skea, M. de Bruin & and the REBALANCE team. International Journal of Obesity (2021) The Original Article was published on 04 June 2021 Correction to: International Journal of Obesity https://doi.org/10.1038/s41366-021-00849-8Peer reviewedPublisher PD

Bariatric surgery, lifestyle interventions and orlistat for severe obesity : the REBALANCE mixed-methods systematic review and economic evaluation

Funding: The National Institute for Health Research Health Technology Assessment programme. 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. Corrigendum: Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Alison Avenell, Clare Robertson, Zoë Skea, Elisabet Jacobsen, Dwayne Boyers, David Cooper, Magaly Aceves-Martins, Lise Retat, Cynthia Fraser, Paul Aveyard, Fiona Stewart, Graeme MacLennan, Laura Webber, Emily Corbould, Benshuai Xu, Abbygail Jaccard, Bonnie Boyle, Eilidh Duncan, Michal Shimonovich, Marijn de Bruin, 2020, vol. 22, issue 68, p. 247-250. Health technology assessment (Winchester, England) Link to publication in Scopus. DOI.http://dx.doi.org/10.3310/hta22680-c202005Peer reviewedPublisher PD

Estimating the costs of air pollution to the National Health Service and social care : An assessment and forecast up to 2035

BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status

Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies

The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, and identify public health interventions that could impact on these risk factors to reduce the burden of liver disease

Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies

Background & Aims: The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, and identify public health interventions that could impact on these risk factors to reduce the burden of liver disease. Methods: As part of the HEPAHEALTH project, commissioned by EASL, we extracted information on historical and current prevalence and mortality from national and international literature and databases on liver disease in 35 countries in the WHO European region, as well as historical and recent prevalence data on their main determinants; alcohol consumption, obesity and hepatitis B and C virus infections. We extracted information from peer-reviewed and grey literature to identify public health interventions targeting these risk factors. Results: The epidemiology of liver disease is diverse and countries cluster with similar pictures, although the exact composition of diseases and the trends in risk factors which drive them is varied. Prevalence and mortality data indicate that increasing cirrhosis and liver cancer may be linked to dramatic increases in harmful alcohol consumption in Northern European countries, and viral hepatitis epidemics in Eastern and Southern European countries. Countries with historically low levels of liver disease may experience an increase in non-alcoholic fatty liver disease in the future, given the rise of obesity across the majority of European countries. Interventions exist for curbing harmful alcohol use, reducing obesity, preventing or treating viral hepatitis, and screening for liver disease at an early stage. Conclusions: Liver disease in Europe is a serious issue, with increasing cirrhosis and liver cancer. The public health and hepatology communities are uniquely placed to implement measures aimed at reducing their causes: harmful alcohol consumption, child and adult obesity prevalence and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease. Lay summary: The European region has seen dramatic increases in liver disease mortality and morbidity in recent decades as a result of changes in the underlying risk factors: excessive alcohol consumption, obesity and viral hepatitis. However, there are highly effective ways to combat these, for example increasing the price of alcohol, making it less readily available, reducing the number of calories, sugar and fat in foods we consume, or screening people earlier to treat them more effectively. The time is now for governments, the health system and individuals to implement the changes required to substantially reduce the burden of liver disease

Exploring the psychological wellbeing of women with gestational diabetes mellitus (GDM): increased risk of anxiety in women requiring insulin. A Prospective Longitudinal Observational Pilot Study

ABSTRACTIntroduction Gestational diabetes mellitus (GDM) complicates ∼16% of pregnancies in Australia and has significant implications for health of both mother and baby. Antenatal anxiety and depression are also associated with adverse pregnancy outcomes. The interaction between GDM and mental health in pregnancy is poorly understood. With the aim of exploring the nuanced interaction between GDM and mental health further, we investigated whether GDM treatment modality (diet versus insulin) influenced psychological wellbeing in women with GDM.Methods Psychological wellbeing was assessed in women with GDM treated with diet (GDM-Diet, n = 20) or insulin (GDM-Insulin, n = 15) and pregnant women without GDM (non-GDM, n = 20) using questionnaires [Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI-6), and in women with GDM, Problem Areas in Diabetes (PAID)] at 24–34 weeks gestation and again at ∼36 weeks gestation.Results Women in the GDM-insulin group had significantly higher levels of anxiety than the non-GDM group at both time points. Women in the GDM-Diet group had higher levels of anxiety at 24–34 weeks gestation than the non-GDM group but did not differ at ∼36 weeks gestation. Although depression scores tended to be higher in GDM-Insulin and GDM-Diet groups than in the non-GDM group at both time points, this was not statistically significant. Diabetes-related distress was similar in the GDM-Diet and GDM-Insulin groups at both time points and did not change during pregnancy. A high proportion of the GDM-Insulin group had past/current mental illness (60%).Conclusions In this pilot study GDM was associated with differences in psychological wellbeing, specifically increased anxiety in women treated with insulin. Specialised interventions to support women with GDM should be considered, especially those requiring insulin.Trial registration: Not applicable as this was a purely observational study

Total disease cases and costs attributable to PM_2.5 and NO₂.

<p>Total disease cases and costs attributable to PM_2.5 and NO₂.</p

Costs attributable to PM_2.5 and NO₂ by 2035 for each cost parameter.

<p>The confidence limits that accompany the sets of output data represent the accuracy of the microsimulation as opposed to the confidence of the input data itself. Confidence intervals around the input data were not available.</p

Cost based on total prevalence of each disease, expressed in British pounds per prevalence case per year.

<p>Cost based on total prevalence of each disease, expressed in British pounds per prevalence case per year.</p

Summary of cumulative incidence of cases avoided and cumulative costs avoided in England for each scenario relative to baseline for PM_2.5 and NO₂, by period.

<p>Summary of cumulative incidence of cases avoided and cumulative costs avoided in England for each scenario relative to baseline for PM_2.5 and NO₂, by period.</p