Health technology assessment of non-invasive interventions for weight loss and body shape in Iran

Background: The burden of obesity and diet-related chronic diseases is increasing in Iran, and prevention and treatment strategies are needed to address this problem. The aim of this study was to determine the outcome, cost, safety and cost-consequence of non-invasive weight loss interventions in Iran.   Methods: We performed a systematic review to compare non-invasive interventions (cryolipolysis and radiofrequency/ ultrasonic cavitation) with semi-invasive (lipolysis) and invasive (liposuction).  A sensitive electronic searching was done to find available interventional studies. Reduction of abdomen circumference (cm), reduction in fat layer thickness (%) and weight reduction (kg) were outcomes of efficacy. Meta-analysis with random models was used for pooling efficacy estimates among studies with the same follow-up duration. Average cost per intervention was estimated based on the capital, maintenance, staff, consumable and purchase costs.   Results: Of 3,111 studies identified in our reviews, 13 studies assessed lipolysis, 10 cryolipolysis and 8 considered radiofrequency. Nine studies with the same follow-up duration in three different outcome group were included in meta-analysis. Radiofrequency showed an overall pooled estimate of 2.7 cm (95% CI; 2.3-3.1) of mean reduction in circumference of abdomen after intervention. Pooled estimate of reduction in fat layer thickness was 78% (95% CI; 73%-83%) after Lipolysis and   a pooled estimate of weight loss was 3.01 kg (95% CI; 2.3-3.6) after lipousuction. The cost analysis revealed no significant differences between the costs of these interventions.   Conclusion: The present study showed that non-invasive interventions appear to have better clinical efficacy, specifically in the body shape measurement, and less cost compared to invasive intervention (liposuction).