Taffy Makaya, Rebecca Poole and Kavitha Rozario
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agenda of all CCGs. To support decisions on spending priorities,
measurements of outcome rather than process are often required. An economic
perspective led to the development of the ‘quality adjusted life years’
(QALYs) [132]. This is essentially a measure used by cost-utility analysts to
calculate cost effectiveness of a particular medical intervention. It is a health
status index which measures disease burden by including both the quantity and
quality of life the lived. In general a beneficial health care activity is one that
generates a positive level of QALYs, and an efficient health care activity is
one where the cost per QALY is as low as it can be [133]. Comparisons are
made between interventions, and priorities can be made based on those
interventions that are low cost per QALY (relatively inexpensive) and those
that are high cost per QALY (relatively expensive).
It is not surprising therefore that some CCGs are not convinced that
spending thousands of pounds on one individual for what is viewed by many
as a ‘life-style disease’ is the best option. There is still a great belief in many
areas that obesity should be managed within the community. Another point of
view may simply be that some CCGs are still being cautious about bariatric
surgery in childhood and they are awaiting further, longer-term outcomes
before committing to this as a standard treatment option.
There are 4 centres in England which perform bariatric surgery in
children: Sheffield Children’s Hospital (SCH), University College London
Hospital (UCLH), Bristol Royal Hospital for Children (BRHC) and King’s
College Hospital (KCH).
Sheffield published their data in 2015 [123]. Between 2004 and 2012 six
patients (4 male) aged 14- 16 years (mean age 15.10) underwent bariatric
surgery. Bristol has not yet formally published their data but over the last 10
years they have operated on 8 children (personal correspondence via Email).
UCLH have performed several operations (data unpublished), while Kings
College have the highest number of surgeries (data unpublished). In 2014
King’s College London and King’s College Hospital – part of King’s Health
Partners Academic Health Sciences Centre (AHSC) established the first
university chair in metabolic surgery when they appointed Professor Francesco
Rubino as Professor of metabolic Surgery [134].
Over the years it has become apparent there is not enough density of
bariatric surgery in children in individual centres to allow sufficient
information gathering. The Paediatric Research in Obesity Multi-modal
Intervention and Service Evaluation (PROMISE) initiative was established to
facilitate information gathering and sharing for childhood obesity [135]. There
are several studies running under this umbrella programme including Study E: