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Cost-effectiveness of pharmacological anti-obesity treatments: a systematic review

International Journal of Obesity volume 32, pages 1752–1763 (2008)Cite this article

Abstract

Aim:

To review economic evaluations of weight loss drugs and compare reported incremental cost-effectiveness ratios (ICERs).

Methods:

A literature search was conducted for cost-effectiveness (CEAs) and cost-utility analyses (CUAs) of sibutramine, orlistat and rimonabant.

Results:

Fourteen unique articles were identified (11 CUAs and 3 CEAs; 9 orlistat, 4 sibutramine and 1 rimonabant). All used diet and exercise as comparator, whereas none included indirect costs. Time horizons varied from treatment period only (1–4 years) to 80 years (median 7.5 years). Longer studies modeled effects on diabetes, micro- and macrovascular complications, coronary heart disease and death. Of the CUAs, the median ICER was €200716 000/QALY (quality-adjusted life-year; range 10 000–88 000), with the worst cost-effectiveness when recommended stop rules for non-responding patients were not applied. All studies but three were funded by the manufacturing company, and the median ICER was considerably higher for independent than for sponsored analyses (€62 000 vs €15 000/QALY). However, two of the three independent CUAs did not use recommended stop rules, as compared with one of eight manufacturer-sponsored analyses. The results were most sensitive to assumptions regarding weight loss sustainability and utility per kilogram lost. Side effects and dropout because of reasons other than lack of efficacy were generally not incorporated.

Conclusion:

Published economic evaluations indicate that orlistat, sibutramine and rimonabant are within the range of what is generally regarded as cost-effective. Uncertainty remains about weight loss sustainability, utility gain associated with weight loss and extrapolations from transient weight loss to long-term health benefits. Modeling of head-to-head comparisons and attrition is needed, as are analyses conducted independently of manufacturing companies.

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Acknowledgements

This study is an update and expansion of parts of an earlier published book chapter in Swedish on health economics and obesity (Narbro and Neovius, Hälsoekonomi, In: Lindroos, Rössner (eds). Fetma—från gen till samhällspåverkan, 2007). MN has earlier received consultancy fees from Abbott and Sanofi-Aventis.

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Authors and Affiliations

  1. Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden

    M Neovius

  2. Department of Health Care, Regional Secretariat, Västra Götaland Region, Göteborg, Sweden

    K Narbro

  3. Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    K Narbro

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  1. M Neovius
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  2. K Narbro
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Correspondence to M Neovius.

Appendices

Appendix 1

Detailed search string for PubMed

PubMed

Date of search: 31 May 2008

((“obesity”[MeSH Terms] OR “obesity”[All Fields]) OR (“obesity”[MeSH Terms] OR “obesity”[All Fields] OR “obese”[All Fields]) OR (“overweight”[MeSH Terms] OR “overweight”[All Fields])) AND ((“economics”[Subheading] OR “economics”[All Fields] OR “cost”[All Fields] OR “costs and cost analysis”[MeSH Terms] OR (“costs”[All Fields] AND “cost”[All Fields] AND “analysis”[All Fields]) OR “costs and cost analysis”[All Fields]) AND (effectiveness[All Fields] OR utility[All Fields])) AND ((“orlistat”[Substance Name] OR “orlistat”[All Fields]) OR (“sibutramine”[Substance Name] OR “sibutramine”[All Fields]) OR (“rimonabant”[Substance Name] OR “rimonabant”[All Fields]) OR (“orlistat”[Substance Name] OR “orlistat”[All Fields] OR “xenical”[All Fields]) OR (“sibutramine”[Substance Name] OR “sibutramine”[All Fields] OR “reductil”[All Fields]) OR (“rimonabant”[Substance Name] OR “rimonabant”[All Fields] OR “acomplia”[All Fields]) OR (“orlistat”[Substance Name] OR “orlistat”[All Fields] OR “alli”[All Fields]) OR (“sibutramine”[Substance Name] OR “sibutramine”[All Fields] OR “meridia”[All Fields]) OR (“rimonabant”[Substance Name] OR “rimonabant”[All Fields]))

Appendix 2

Factors for weight/BMI conversion Table A1

Table 3 Table a1
Full size table

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Neovius, M., Narbro, K. Cost-effectiveness of pharmacological anti-obesity treatments: a systematic review. Int J Obes 32, 1752–1763 (2008). https://doi.org/10.1038/ijo.2008.189

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