OBESITY, COMORBIDITIES, AND ECONOMIC EVALUATIONS OF SURGICAL TREATMENTS OF OBESIT

描述（由申请人提供）：超重和肥胖的流行在全球范围内正在增加，这被认为是造成大量慢性疾病和癌症的原因。肥胖的手术治疗已被证明在长期体重控制方面是有效的，为患有肥胖相关疾病的人提供了额外的好处，并降低了相对的死亡风险。然而，并不是所有类型的肥胖者都能普遍使用。拟议的研究将仔细检查减肥手术的成本和效果。最终目标是检查当前NIH指南的适当性，并告知保险公司、患者、提供者和政府最具成本效益的肥胖手术治疗方法。研究的具体目的是：(1)研究肥胖、肥胖相关的合并症和死亡率之间的关系；(2)评价减肥手术的安全性和有效性；(3)调查肥胖相关疾病的成本；(4)对减肥手术进行成本-后果分析。研究方法包括计量经济模型（研究具体目标1和3）、元分析（研究具体目标2）、微观模拟（研究具体目标3和4）和成本效益分析（研究具体目标4）。为使申请人顺利完成拟进行的研究，本计划亦会为申请人提供三名专家的指导，并配合教学训练，使申请人成长为一名有效率及有经验的学者

DESCRIPTION (provided by applicant): The prevalence of overweight and obesity is increasing globally, which is thought to account for a substantial number of chronic diseases and cancers. Surgical treatment of obesity has been shown to be effective in long- term weight control, provide additional benefits to people with obesity-related diseases, and reduce relative risk of death. However, it is not universally available to all classes of obese people. The proposed research will closely examine the costs and effectiveness of bariatric surgery. The ultimate goal is to examine the appropriateness of current NIH guidelines and to inform insurance companies, patients, providers, and the government of the most cost-effective surgical treatment of obesity. The Research Specific Aims are to (1) examine the association between obesity, obesity-related comorbidities, and mortality; (2) evaluate the safety and effectiveness of bariatric surgery; (3) investigate the costs attributable to obesity-related diseases; and (4) conduct cost-consequence analyses of bariatric surgery. The research methodology includes econometric modeling (Research Specific Aim 1 and 3), meta-analysis (Research Specific Aim 2), microsimulation (Research Specific Aim 3 and 4), and cost-effectiveness analysis (Research Specific Aim 4). In order to successfully complete the proposed research, this project will also provide the applicant with mentoring by three experts who, in conjunction with didactic training, will enable the applicant to grow into an effective and independent health services research investigator and health economist in obesity prevention and control. The mentoring team and the applicant have worked together and identified three Career Development Aims: (1) to become an independent and externally-funded researcher; (2) to obtain working knowledge of obesity epidemiology and gastroenterology; (3) to enhance the quality of research by obtaining training in the areas of public health and quantitative modeling. These aims will be achieved through a variety of training strategies, including regular one-on-one meetings with each of three mentors who are experts in the relevant domains, didactic coursework, high-quality online training modules, and attendance at scientific conferences and workshops. The proposed research will provide preliminary data and results for several R21 and an R01 or equivalent applications. These projects will expand to examine other interventions to control obesity, e.g., exercise, diet, medications, and surgery and will be compared within a metric of intensity; alternatively, these projects will examine the relationship between obesity and cancer and how interventions to control obesity can alter this relationship.