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.
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References
Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. J Am Med Assoc 2002; 288: 1723–1727.
Groscurth A, Vetter W, Suter PM . Is the Swiss population gaining body weight? Body mass index insurance applications between 1950 and 1990. Schweiz Rundsch Med Prax 2003; 92: 2191–2200.
Dotevall A, Johansson S, Wilhelmsen L, Rosengren A . Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. A prospective 18-year follow-up of the BEDA study. Diabet Med 2004; 21: 615–622.
Colditz GA, Willett WC, Rotnitzky A, Manson JE . Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 122: 481–486.
Henriksson F, Agardh CD, Berne C, Bolinder J, Lönnqvist F, Stenström P, Östenson CG, Jönsson B . Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387–396.
Schmitt-Koopmann I, Schwenkglenks M, Spinas GA, Szucs TD . Direct medical costs of type 2 diabetes and its complications in Switzerland. Eur J Public Health 2004; 14: 3–9.
Segal L, Carter R, Zimmet P . The cost of obesity: the Australian perspective. Pharmacoeconomics 1994; 5 (Suppl 1): 45–52.
American Diabetes Association. Standards of Medical Care for Patients with Diabetes Mellitus. Diabetes Care 2002; 25: 213–229.
Yanovski SZ, Yanovski JA . Obesity. N Engl J Med 2002; 346: 591–602.
Berne C . Randomised study of orlistat in combination with a weight management programme in obese patients with type 2 diabetes treated with metformin. Diabetes Med 2005 (in press).
Kelley DE, Bray GA, Pi-Sunyer FX, Klein S, Hill J, Miles J, Hollander P . Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1 year randomized controlled trial. Diabetes Care 2002; 25: 1033–1041.
Miles JM, Leiter L, Hollander P, Wadden T, Anderson JW, Doyle M, Foreyt J, Aronne L, Klein S . Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care 2002; 25: 1123–1128.
Hollander P, Elbein SC, Hirsch IB, Kelley D, McGill J, Taylor T, Weiss SR, Crocket SE, Kaplan RA, Comstock J, Lucas CP, Lodewick PA, Canovatchel W, Chung J, Hauptman J . Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year, randomized, double-blind study. Diabetes Care 1998; 21: 1288–1294.
Hanefeld M, Sachse G . The effects of orlistat on body weight and glycemic control in overweight patients with type 2 diabetes: a randomized, placebo-controlled trial. Diab Obes Metab 2002; 4: 415–423.
Serrano-Rios M, Armero F, Genis M . Orlistat efficacy on weight loss in overweight or obese patients with type 2 diabetes mellitus. Spanish randomized clinical trial. Poster presented at American Diabetes Association annual scientific sessions 2001, Philadelphia.
Deerochanawong C . Effect of treatment with orlistat in overweight or obese Thai patients with type 2 diabetes. Poster presented at American Diabetes Association annual scientific sessions 2001, Philadelphia.
Bonnici F . Effect of orlistat on glycemic control and body weight in overweight or obese South African patients with type 2 diabetes. Poster presented at American Diabetes Association annual scientific sessions 2001, Philadelphia.
Sonnenberg FA, Beck JR . Markov models in medical decision making: a practical guide. Med Decis Making 1993; 13: 322–338.
Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR . Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–412.
Hakim Z, Wolf A, Garrison L . Estimating the effects of changes in body mass index on health state preferences. Pharmacoeconomics 2002; 20: 393–404.
Hautpman J, Charles L, Boldrin M, Collins H, Segal KR . Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 2000; 9: 160–167.
Lamotte M, Annemans L, Lefever A, Nechelput M, Masure J . A health economic model to assess the long-term effects and cost-effectiveness of orlistat in obese type 2 diabetic patients. Diabetes Care 2002; 25: 303–308.
Maetzel A, Ruof J, Covington M, Wolf A . Economic evaluation of orlistat in overweight and obese patients with type 2 diabetes mellitus. Pharmacoeconomics 2003; 21: 501–512.
Rissanen A, Lean M, Rössner S, Segal KR, Sjöström L . Predictive values of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes Relat Metab Disord 2003; 27: 103–109.
Albu J, Raja-Kahn N . The management of the obese diabetic patient. Primary Care 2003; 30: 465–491.
Wing RR, Marcus MD, Epstein LH, Salata R . Type II diabetic subjects lose less weight than their overweight spouses. Diabetes Care 1987; 10: 563–566.
Mark DB, Hlatky MA, Califf RM, Naylor CD, Lee KL, Armstrong PW, Barbash G, White H, Simoons ML, Nelson CL . Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995; 332: 1418–1424.
Hiatt MD . Thrombolytic therapy with streptokinase and tissue plasminogen activator in a patient with suspected acute myocardial infarction: a decision analysis. Cardiology 1999; 91: 243–249.
Sullivan SD, Lew DP, Devine EB, Hakim Z, Reiber G, Veenstra D . Health state preference assessment in diabetic peripheral neuropathy. Pharmacoeconomics 2002; 20: 1079–1089.
Churchill DN, Torrance GW, Taylor DW, Barnes CC, Ludwin D, Shimizu A, Smith EK . Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 1987; 10: 14–20.
Havranek EP, McGovern KM, Weinberger J, Brocato A, Lowes BD, Abraham WT . Patient preferences for heart failure treatment: utilities are valid measures of health-related quality of life in heart failure. J Card Fail 1999; 5: 85–91.
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Ruof, J., Golay, A., Berne, C. et al. Orlistat in responding obese type 2 diabetic patients: meta-analysis findings and cost-effectiveness as rationales for reimbursement in Sweden and Switzerland. Int J Obes 29, 517–523 (2005). https://doi.org/10.1038/sj.ijo.0802925
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DOI: https://doi.org/10.1038/sj.ijo.0802925
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