Another APPLES Study

For what may appear rather unimaginative, obesity researchers seem to like the acronym APPLE(S) for their studies.

Thus, some readers may be aware that there is an ongoing APPLE School project led by the University of Alberta, which looks at school interventions to prevent childhood obesity.

In a paper just published in BMC Health Services Research, we describe the background, objectives and protocol of another APPLES study, namely the ongoing Alberta Population-based Prospective evaluation of the quality of Life outcomes and Economic impact of bariatric Surgery.

This project is led by my colleague Raj Padwal and is primarily funded through a grant by the Canadian Institutes of Health Research (CIHR).

As readers are well aware, extreme obesity affects nearly 8% of Canadians and bariatric surgery is currently the most effective treatment available.

However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times.

The key objectives the APPLES study are:

1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time;

2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life;

3. To conduct a 3-year (1 year retrospective and 2 year prospective) economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery.

Taking full advantage of the extensive reach within an entirely publicly funded bariatric program, we have recruited a population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients with severe obesity.

All subjects receive a bi-annual follow-up for 2 years. Data will be linked to provincial administrative databases to determine full costs and outcomes in these participants.

Major outcomes include generic, obesity-specific and preference-based quality of life assessment, patient satisfaction, patient utilities, anthropometric indices, cardiovascular risk factors, health care utilization and direct and indirect costs.

We hope that the results will help better identify the spectrum of potential risks associated with protracted wait times for bariatric care and will quantify the economic, humanistic and clinical impact of surgery from the Canadian perspective.

Such information is urgently needed by health-service providers and policy makers to better allocate use of finite resources.

Recruitment for this trial ended earlier this year and the final results are expect in 2012.

We are grateful to all participants in this registry, who have kindly contributed their time and enthusiasm to address this pressing scientific question.

Edmonton, Alberta

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Padwal RS, Majumdar SR, Klarenbach SW, Birch DW, Karmali S, McCargar L, Fassbender K, & Sharma AM (2010). The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: background, design and rationale. BMC health services research, 10 (1) PMID: 20932316