Prioritization for bariatric surgery: capturing Canadian patient preference weights using a discrete choice experiment.

BACKGROUND

Bariatric surgery is an effective treatment for adults affected by obesity. Demand is greater than supply and a prioritization system for patients is needed.

OBJECTIVE

Clinical practice guidelines recommends bariatric surgery as a management strategy for adults with severe obesity (body mass index ≥40 or 35-40 kg/m with co-morbidities). Eligible patient's access surgery on a first-come-first-serve basis and wait times can be several years. This study quantifies patient preferences toward attributes that could be evaluated when prioritizing patients for surgery.

SETTING

A Canada-wide study of adults living with obesity.

METHODS

A discrete choice experiment was conducted via email with a sample of Canadian adults with obesity. Six relevant attributes were identified through focus groups. Respondents completed 12 choice tasks and demographic and weight loss-related questions. A multinomial logit model was used to estimate preference weights of each attribute.

RESULTS

A total of 515 individuals completed the survey. Fifty-nine percent were female, 97% made previous weight loss attempts, and 5% had bariatric surgery. On average patients prioritized individuals with significant problems with daily activities versus none (odds ratio [OR] 4.41; 95% confidence interval [CI] 4.31-4.52); 3 existing cardiovascular co-morbidities versus 0 (OR 4.24; 95%CI 4.12-4.36); extreme impact on mental health versus no impact (OR 3.73; 95%CI 3.64-3.84); 6 other co-morbidities versus 0 (OR 3.43; 95%CI 3.31-3.55); waiting 5 versus 1 year (OR 1.59; 95%CI 1.46-1.68); and a body mass index of 60 versus 40 (OR 1.52; 95%CI 1.43-.62).

CONCLUSION

All 6 attributes were important to patients in the prioritization for bariatric surgery. However, the number of cardiovascular co-morbidities and the impact on daily activities were considered most important.