Assessment of the business case for the Management of Adult Morbid Obesity in New ZealandNational Service & Technology Review Advisory Committee (NSTR)
Date of publication: August 2008
Context
The National Service and Technology Review Advisory Committee (NSTR) considered the Management of Adult Morbid Obesity in New Zealand in the context of:
- the New Zealand Health Strategy to improve nutrition, increase physical activity and reduce obesity
- high obesity levels in New Zealand and accurate statistics for the prevalence of morbid obesity
- the Health Select Committee in its August 2007 report “Inquiry into Obesity and Type 2 Diabetes in New Zealand” recommended ‘that the provision of publicly-funded bariatric surgery be explored as a last resort for people who are morbidly obese’
- ensuring co ordinated equity of access to publically funded bariatric surgery across New Zealand.
Recommendations
NSTR recommends that the District Health Board (DHB) CEOs and the Ministry of Health’s Executive Leadership Team (ELT) note that:
1. the cost of a 0.5% intervention rate is ~$17.1 million in the first year in which the intervention rate is reached, as per the modelling provided in the business case, declining to a net cost of ~$15.9 million in Year 2, ~$14.5 million in Year 3, ~$13.2 million in Year 4 and ~$11.2 million in Year 5 as savings are realised
2. bariatric surgery should be prioritised using existing patient selection criteria and that this should occur alongside prioritisation for other general surgical procedures
3. based on expert opinion, DHBs may consider including wrap-around services as an adjunct to bariatric surgery. It is acknowledged, however, that there is currently insufficient evidence in the literature to support this more strongly. This is the subject of the Counties Manukau DHB pilot study
4. there is a mix of public and private capacity available to provide the service
5. further research into non-surgical interventions is required for those who are not suitable for surgery, although such research is outside the scope of this business case
6. normal project assurance will apply.
NSTR recommends that the DHB CEOs and the Ministry’s ELT support:
7. new funding being made available for standard care pathway (bariatric surgery and dietary advice) for bariatric surgery based on the strength of the findings of the business case
8. that funding is available through additional Elective Services initiatives to undertake bariatric surgery.
NSTR recommends that the DHB CEOs and the Ministry’s ELT agree that:
9. DHBs use their existing nationally recognised general surgery prioritisation criteria to assign priority for bariatric cases amongst their wider general surgical cases
10. the standard care pathway for bariatric surgery be publicly funded in New Zealand for the management of those who are morbidly obese
11. to achieve geographic equity, each DHB agree to aim for an intervention rate of 0.5% of its morbidly obese population – at current estimates this equates to 915 bariatric procedures nationally
12. provision of bariatric surgical units be dependent upon each DHB or region having the surgeon capacity and volume, and the physical capacity, required for a clinically and financially viable service
13. the development of bariatric surgical units follow the guidelines of the International Federation for the Surgery of Obesity guidelines for Bariatric Institutions
14. a National Implementation Group be established to support the implementation of bariatric surgery. This Group would in principle be led and supported by the Ministry of Health’s Elective Services Team
15. there will in time be a nationally funded longitudinal study of equity of access, outcomes, and other key performance indicators to plan for the future of the service. This study should be initiated and co ordinated by the National Implementation Group.
Related information
Service Planning and New Health Intervention Assessment (SPNIA)
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Publishing information
Date of publication: August 2008
ISBN numbers: 978-0-478-31797-8 (Online)
HP number: 4631
Citation: Ministry of Health. 2008. NSTR Assessment of the Business Case for the Management of Adult Morbid Obesity in New Zealand. Wellington: Ministry of Health. |
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