Paper
International Journal of Obesity (2005) 29, 517–523. doi:10.1038/sj.ijo.0802925 Published online 1 March 2005
Orlistat in responding obese type 2 diabetic patients: meta-analysis findings and cost-effectiveness as rationales for reimbursement in Sweden and Switzerland
J Ruof1,2, A Golay3, C Berne4, C Collin5, J Lentz6 and A Maetzel7
- 1Health Services Research Unit, Division of Rheumatology, Center of Internal Medicine, Hannover Medical School, Hannover, Germany
- 2Global Health Economics Department, Roche Pharmaceuticals, Basel, Switzerland
- 3Teaching Diabetic Division, University Hospital, Geneva, Switzerland
- 4Department of Medicine, University Hospital, Uppsala, Sweden
- 5Business Development, Roche Pharmaceuticals, Stockholm, Sweden
- 6Roche Pharmaceuticals, Reinach, Switzerland
- 7University Health Network, Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Correspondence: Dr DJ Ruof, Division of Rheumatology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. E-mail: joerg.ruof@roche.com
Received 4 February 2004; Revised 10 December 2004; Accepted 16 January 2005; Published online 1 March 2005.
Abstract
OBJECTIVE:
The aim of this study is to review the clinical and economic rationale for the reimbursement of orlistat in responding obese patients with type 2 diabetes.
METHODS:
Data from seven randomized controlled clinical trials of orlistat in overweight and obese patients with type 2 diabetes were pooled. A subgroup analysis involving patients who achieved a response (defined as a weight loss of 
5% after 12 weeks of treatment) was conducted. The outcomes of the pooled analysis were then used to construct a Markov health economic model covering an 11-y period. The incidences of diabetes-related micro- and macrovascular complications were derived from the United Kingdom Prospective Diabetes Study. The effects of changes in body mass index, and the impact of micro- and macrovascular complications on utilities were derived from published sources. Publicly available cost data were used and are presented here in 2001 Euros. Discounting of 3% was applied. A probabilistic sensitivity analysis was conducted to examine the robustness of results.
RESULTS:
A total of 1249 patients treated with orlistat and 1230 given placebo were eligible for the intent-to-treat analysis. At the end of the study period, 23% of orlistat patients achieved a weight reduction of 5%. These patients showed a mean decrease in HbA1C of 1.16%, a weight reduction of 8.6 kg, a reduction in total cholesterol of 5.3% and a reduction in systolic blood pressure of 5.2 mmHg. The base-case economic analysis revealed costs per quality-adjusted life year gained of 
14 000 in Sweden and 13 600 in Switzerland.
CONCLUSION:
The data presented here support the utilization and reimbursement of orlistat in overweight and obese diabetic patients who respond to the treatment.
Keywords:
orlistat, cost-effectiveness, diabetes, reimbursement, meta-analysis
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