Magda Aguiar1, Emma Frew1, Susan P Mollan2, James L Mitchell3,4, Ryan S Ottridge5, Zerin Alimajstorovic3,6, Andreas Yiangou3,4, Rishi Singhal6,7, Abd A Tahrani3,8,9, Alex J Sinclair3,4,8. 1. Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B12 2TT, UK. 2. Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK. 3. Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK. 4. Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK. 5. Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK. 6. Upper GI Unit and Minimally Invasive Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B9 5SS, UK. 7. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK. 8. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2GW, UK. 9. Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK.
Abstract
BACKGROUND: The Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) established the efficacy of bariatric surgery as compared to a community weight management intervention in reducing intracranial pressure in active IIH. The aim of this cost-effectiveness analysis was to evaluate the economic impact of these weight loss treatments for IIH. METHODS:IIH:WT was a five-year randomised, controlled, parallel group, multicentre trial in the United Kingdom, where participants with active IIH and a body mass index ≥35 kg/m2 were randomly assigned (1:1) to receive access to bariatric surgery or a community weight management intervention. All clinical and quality of life data was recorded at baseline, 12 and 24 months. Economic evaluation was performed to assess health-care costs and cost-effectiveness. Evaluations were established on an intention to treat principle, followed by a sensitivity analysis using a per protocol analysis. RESULTS: The mean total health care costs were GBP 1353 for the community weight management arm and GBP 5400 for the bariatric surgery arm over 24 months. The majority of costs for the bariatric surgery arm relate to the surgical procedure itself. The 85% who underwent bariatric surgery achieved a 12.5% reduction in intracranial pressure at 24 months as compared to 39% in the community weight management arm; a mean difference of 45% in favour of bariatric surgery. The cost effectiveness of bariatric surgery improved over time. CONCLUSIONS: The IIH:WT was the first to compare the efficacy and cost-effectiveness of bariatric surgery with community weight management interventions in the setting of a randomised control trial. The cost-effectiveness of bariatric surgery improved over time and therefore the incremental cost of surgery when offset against the incremental reduction of intracranial pressure improved after 24 months, as compared with 12 months follow up.
RCT Entities:
BACKGROUND: The Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) established the efficacy of bariatric surgery as compared to a community weight management intervention in reducing intracranial pressure in active IIH. The aim of this cost-effectiveness analysis was to evaluate the economic impact of these weight loss treatments for IIH. METHODS: IIH:WT was a five-year randomised, controlled, parallel group, multicentre trial in the United Kingdom, where participants with active IIH and a body mass index ≥35 kg/m2 were randomly assigned (1:1) to receive access to bariatric surgery or a community weight management intervention. All clinical and quality of life data was recorded at baseline, 12 and 24 months. Economic evaluation was performed to assess health-care costs and cost-effectiveness. Evaluations were established on an intention to treat principle, followed by a sensitivity analysis using a per protocol analysis. RESULTS: The mean total health care costs were GBP 1353 for the community weight management arm and GBP 5400 for the bariatric surgery arm over 24 months. The majority of costs for the bariatric surgery arm relate to the surgical procedure itself. The 85% who underwent bariatric surgery achieved a 12.5% reduction in intracranial pressure at 24 months as compared to 39% in the community weight management arm; a mean difference of 45% in favour of bariatric surgery. The cost effectiveness of bariatric surgery improved over time. CONCLUSIONS: The IIH:WT was the first to compare the efficacy and cost-effectiveness of bariatric surgery with community weight management interventions in the setting of a randomised control trial. The cost-effectiveness of bariatric surgery improved over time and therefore the incremental cost of surgery when offset against the incremental reduction of intracranial pressure improved after 24 months, as compared with 12 months follow up.
Entities:
Keywords:
bariatric surgery; cost-effectiveness; headache; health care system; intracranial pressure; national health service; obesity; papilloedema; pseudotumor cerebri; randomised control trial
Authors: Susan P Mollan; Olivia Grech; Zerin Alimajstorovic; Benjamin R Wakerley; Alexandra J Sinclair Journal: Br Med Bull Date: 2020-12-15 Impact factor: 4.291
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Authors: Jonathan M Hazlehurst; Jennifer Logue; Helen M Parretti; Sally Abbott; Adrian Brown; Dimitri J Pournaras; Abd A Tahrani Journal: Curr Obes Rep Date: 2020-11-12
Authors: Susan P Mollan; James L Mitchell; Ryan S Ottridge; Magda Aguiar; Andreas Yiangou; Zerin Alimajstorovic; David M Cartwright; Olivia Grech; Gareth G Lavery; Connar S J Westgate; Vivek Vijay; William Scotton; Ben R Wakerley; Tim D Matthews; Alec Ansons; Simon J Hickman; James Benzimra; Caroline Rick; Rishi Singhal; Abd A Tahrani; Kristian Brock; Emma Frew; Alexandra J Sinclair Journal: JAMA Neurol Date: 2021-06-01 Impact factor: 18.302
Authors: Ryan Ottridge; Susan P Mollan; Hannah Botfield; Emma Frew; Natalie J Ives; Tim Matthews; James Mitchell; Caroline Rick; Rishi Singhal; Rebecca Woolley; Alexandra J Sinclair Journal: BMJ Open Date: 2017-09-27 Impact factor: 2.692
Authors: Susan P Mollan; James L Mitchell; Andreas Yiangou; Ryan S Ottridge; Zerin Alimajstorovic; David M Cartwright; Simon J Hickman; Keira A Markey; Rishi Singhal; Abd A Tahrani; Emma Frew; Kristian Brock; Alexandra Jean Sinclair Journal: Neurology Date: 2022-07-05 Impact factor: 11.800
Authors: Andreas Yiangou; James L Mitchell; Matthew Nicholls; Yu Jeat Chong; Vivek Vijay; Benjamin R Wakerley; Gareth G Lavery; Abd A Tahrani; Susan P Mollan; Alexandra J Sinclair Journal: J Neurol Date: 2021-08-22 Impact factor: 4.849