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The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity.
Obes Sci Pract. 2020 Apr; 6(2):162-170.OS

Abstract

Background

The Food and Drug Administration has approved several pharmacotherapies for the treatment of obesity. This study assesses the cost-effectiveness of six pharmacotherapies and lifestyle intervention for people with mild obesity (body mass indices [BMIs] 30 to 35).

Methods

A microsimulation model was constructed to compare seven weight loss strategies plus no treatment: intensive lifestyle intervention, orlistat, phentermine, phentermine/topiramate, lorcaserin, liraglutide, and semaglutide. Weight loss, quality-of-life scores, and costs were estimated using clinical trials and other published literature. Endpoints included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of $100 000/QALY. Results were analysed at 1-, 3-, and 5-year time horizons.

Results

At each of the three follow-up periods, phentermine was the cost-effective strategy, with ICERs of $46 258/QALY, $20 157/QALY, and $17 880/QALY after 1, 3, and 5 years, respectively. Semaglutide was the most effective strategy in the 3- and 5-year time horizons, with total QALYs of 2.224 and 3.711, respectively. However, the ICERs were prohibitively high at $1 437 340/QALY after 3 years and $576 931/QALY after 5 years. Deterministic and probabilistic sensitivity analyses indicated these results were robust.

Conclusions

Phentermine is the cost-effective pharmacologic weight-loss strategy. Although semaglutide is the most effective, it is not cost-effective because of its high price.

Authors+Show Affiliations

Gastroenterology Division Massachusetts General Hospital Boston Massachusetts. Institute for Technology Assessment Massachusetts General Hospital Boston Massachusetts.Department of General Medicine Columbia University Irving Medical Center New York New York. Healthcare Innovation Research and Evaluation Columbia University Irving Medical Center New York New York.Gastroenterology Division Massachusetts General Hospital Boston Massachusetts. Institute for Technology Assessment Massachusetts General Hospital Boston Massachusetts.Department of General Medicine Columbia University Irving Medical Center New York New York. Healthcare Innovation Research and Evaluation Columbia University Irving Medical Center New York New York.Gastroenterology Division Massachusetts General Hospital Boston Massachusetts. Institute for Technology Assessment Massachusetts General Hospital Boston Massachusetts. Yale School of Medicine New Haven Connecticut.Division of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota.Department of Pediatrics Massachusetts General Hospital Boston Massachusetts.Gastroenterology Division Massachusetts General Hospital Boston Massachusetts. Harvard Medical School Boston Massachusetts.Gastroenterology Division Massachusetts General Hospital Boston Massachusetts. Harvard Medical School Boston Massachusetts.Department of General Medicine Columbia University Irving Medical Center New York New York. Healthcare Innovation Research and Evaluation Columbia University Irving Medical Center New York New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32313674

Citation

Lee, Minyi, et al. "The Cost-effectiveness of Pharmacotherapy and Lifestyle Intervention in the Treatment of Obesity." Obesity Science & Practice, vol. 6, no. 2, 2020, pp. 162-170.
Lee M, Lauren BN, Zhan T, et al. The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. Obes Sci Pract. 2020;6(2):162-170.
Lee, M., Lauren, B. N., Zhan, T., Choi, J., Klebanoff, M., Abu Dayyeh, B., Taveras, E. M., Corey, K., Kaplan, L., & Hur, C. (2020). The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. Obesity Science & Practice, 6(2), 162-170. https://doi.org/10.1002/osp4.390
Lee M, et al. The Cost-effectiveness of Pharmacotherapy and Lifestyle Intervention in the Treatment of Obesity. Obes Sci Pract. 2020;6(2):162-170. PubMed PMID: 32313674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity. AU - Lee,Minyi, AU - Lauren,Brianna N, AU - Zhan,Tiannan, AU - Choi,Jin, AU - Klebanoff,Matthew, AU - Abu Dayyeh,Barham, AU - Taveras,Elsie M, AU - Corey,Kathleen, AU - Kaplan,Lee, AU - Hur,Chin, Y1 - 2019/12/10/ PY - 2019/09/05/received PY - 2019/10/29/revised PY - 2019/11/12/accepted PY - 2020/4/22/entrez PY - 2020/4/22/pubmed PY - 2020/4/22/medline KW - cost‐effectiveness analysis KW - obesity KW - pharmacotherapy KW - weight loss SP - 162 EP - 170 JF - Obesity science & practice JO - Obes Sci Pract VL - 6 IS - 2 N2 - Background: The Food and Drug Administration has approved several pharmacotherapies for the treatment of obesity. This study assesses the cost-effectiveness of six pharmacotherapies and lifestyle intervention for people with mild obesity (body mass indices [BMIs] 30 to 35). Methods: A microsimulation model was constructed to compare seven weight loss strategies plus no treatment: intensive lifestyle intervention, orlistat, phentermine, phentermine/topiramate, lorcaserin, liraglutide, and semaglutide. Weight loss, quality-of-life scores, and costs were estimated using clinical trials and other published literature. Endpoints included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of $100 000/QALY. Results were analysed at 1-, 3-, and 5-year time horizons. Results: At each of the three follow-up periods, phentermine was the cost-effective strategy, with ICERs of $46 258/QALY, $20 157/QALY, and $17 880/QALY after 1, 3, and 5 years, respectively. Semaglutide was the most effective strategy in the 3- and 5-year time horizons, with total QALYs of 2.224 and 3.711, respectively. However, the ICERs were prohibitively high at $1 437 340/QALY after 3 years and $576 931/QALY after 5 years. Deterministic and probabilistic sensitivity analyses indicated these results were robust. Conclusions: Phentermine is the cost-effective pharmacologic weight-loss strategy. Although semaglutide is the most effective, it is not cost-effective because of its high price. SN - 2055-2238 UR - https://www.unboundmedicine.com/medline/citation/32313674/The_cost-effectiveness_of_pharmacotherapy_and_lifestyle_intervention_in_the_treatment_of_obesity L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32313674/ DB - PRIME DP - Unbound Medicine ER -
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