Abstract
OBJECTIVE:
To assess the cost-effectiveness of orlistat plus a calorie-controlled diet compared with a calorie-controlled diet alone for the treatment of overweight and obese patients in Ireland.
DESIGN:
Economic modelling techniques using published international efficacy data and Irish cost data were used to estimate the cost-effectiveness of orlistat in obese patients when only responders to treatment (ie achieve 5% weight loss after 3 months of treatment) continue orlistat after 3 months. The model incorporated known relationships between weight loss and quality of life (utility) gain, and weight loss and reduction in risk of type 2 diabetes (T2DM) to predict the impact of weight loss on quality-adjusted-life-years (QALYs) gained and on the onset of T2DM. The costs associated with each treatment arm included the acquisition cost of orlistat, cost of a calorie-controlled dietary programme and monitoring and treatment costs associated with T2DM. An Irish health-care perspective was taken for the analysis, based on 2003 costs.
SUBJECTS:
Weight loss data on 1386 patients from five pivotal orlistat clinical trials with at least 12 months duration were pooled (two American and three primarily European studies). All the studies were randomized, placebo-controlled, multicentre trials with a similar design. The inclusion criteria were BMI ≥28 kg / m2, age ≥18 y, no diagnosed T2DM and the ability to lose 2.5 kg in weight during the introductory period.
MEASUREMENTS:
Cost effectiveness was modelled from these data and presented as incremental cost per QALY.
RESULTS:
When orlistat treatment plus a calorie-controlled diet was compared with a calorie-controlled diet alone, the incremental cost per year was €478. The number needed to treat (NNT) to gain one QALY was estimated to be 35. The incremental cost per QALY gained was within the range considered cost-effective at €16 954. Sensitivity analysis demonstrated an incremental cost per QALY of €11 000–35 000 under a variety of assumptions.
CONCLUSIONS:
Our model suggests that orlistat is effective and cost-effective in obese patients, if after 3 months of treatment, only treatment responders continue treatment.
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References
Dietary habits of the Irish population: results from Slan Annual report 2003. Available at website http://www.healthpromotion.ie/uploaded_docs/Dietary_Habits_Slan_Results.pdf (accessed April 2004).
North / South Ireland Food Consumption Survey, Irish Universities Nutrition Alliance Summary report available at website www.iuna.net (accessed April 2004).
Sjostrom CD, Peltonen M, Wedel H, Sjostrom L . Differential long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000; 36: 20–25.
Field AE, Coakley EA, Must A, Spadano JL, Laird N, Kostz WH, Rimm E, Colditz GA . Impact of overweight on the risk of developing common chronic diseases during a 1-year period. Arch Intern Med 2001; 161: 1581–1586.
Manson J, Colditz GA, Stampfer M, Willett W, Rosner B, Monson R, Speizer R, Hennekens C . A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med 1990; 322: 882–889.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ . Overweight, obesity and mortality from cancer in a prospectively studied cohort of U.S. Adults. N Engl J Med 2003; 348: 1625–1638.
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.
O'Riordan J . Weight management clinics-an Irish audit. Mod Med 2003; 33: 36–38.
Segal L, Carter R, Zimmet P . The cost of obesity: the Australian perspective. Pharmacoeconomics 1994; 5 (Suppl 1): 45–52.
Levy E, Levy P, Le Pen C, Basdevant A . Economic cost of obesity: the French situation. Int J Obes Relat Metab Disord 1995; 19: 788–792.
Detournay B, Fagnani F, Phillippo M, Pribil C, Charles MA, Sermet C, Basdevant A, Eschwege E . Obesity morbidity and health care costs in France: an analysis of the 1991–1992 Medical Care Household Survey. Int J Obes Relat Metab Disord 2000; 24: 151–155.
Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH . The cost of obesity in Canada. Can Med Assoc J 1999; 160: 483–488.
Swinburn B, Ashton T, Gillespie J, Cox B, Menon A, Simmons D, Birbeck J . Health care costs of obesity in New Zealand. Int J Obes Relat Metab Disord 1997; 21: 891–896.
Pereira J, Mateus C, Amaral MJ . Direct costs of obesity in Portugal. J Int Soc Pharmacoeconomics Outcomes Res 2000; 3: 64 (abstract, BT2).
Seidell J . The impact of obesity on health status: some implications for health care costs. Int J Obes Relat Metab Disord 1995; 19 (Suppl): S13–S16.
Wolf A, Colditz G . Current estimates of the economic cost of obesity in the United States. Obes Res 1998; 6: 97–106.
Total Healthcare expenditure details for Ireland available at website www.doh.ie/statistics/stats/sectionl_files/sheet006.htm.
Narbro K, Jonsson E, Larsson B, Waaler H, Wedel H, Sjöström L . Economic consequences of sick-leave and early retirement in obese Swedish women. Int J Obes Relat Metab Disord 1996; 20: 895–903.
Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L . XENical in the prevention of Diabetes in Obese Subjects (XENDOS) Study. Diabetes Care 2004; 27: 155–161.
Barry M . Cost-effectiveness of beta-blocker therapy for patients with chronic heart failure in Ireland. Irish Med J 2002; 95: 176–177.
Barry M, Heerey A . Cost-effectiveness of statins for the secondary prevention of coronary heart disease in Ireland. Irish Med J 2002; 95: 133–135.
Guidance on the use of Orlistat for the Treatment of obesity in adults. NICE Guidance March 2001, available at website www.nice.org.uk (accessed April 2004).
Finer N, James WPT, Kopelman PG, Lean MEJ, Williams G . One year treatment of obesity: a randomised double-blind, placebo controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor. Int J Obes Relat Metab Disord 2000; 24: 306–313.
Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB . Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. A randomised control trial. JAMA 1999; 281: 235–242.
Sjostrom L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, Krempf M . Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients: European Multicentre Orlistat Study Group. Lancet 1998; 352: 167–173.
Rossner S, Sjostrom L, Noack R, Meinders AE, Nosed G . Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. Obes Res 2000; 8: 49–61.
Hill JO, Hauptman J, Anderson JW, Fujioka K, O'Neill PM, Smith D, Zavorai JH, Aronne LJ . Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-year study. Am J Clin Nutr 1999; 69: 1108–1116.
Barajas GMA, Robledo ME, Tomas GN . Quality of life in relation to health and obesity in a primary care center. Rev Esp Salud Publica 1998; 72: 221–231.
Fontaine KR, Cheskin LJ, Barofsky I . Health-related quality of life in obese persons seeking treatment. J Family Pract 1996; 43: 265–270.
Fontaine KR, Bartlett SJ, Barofsky I . Health-related quality of life among obese persons seeking and not currently seeking treatment. Int J Eating Disord 2000; 27: 101–105.
Han TS, Tijhuis MA, Lean ME Seidell JC . Quality of life in relation to overweight and body fat distribution. Am J Public Health 1998; 88: 1814–1820.
Lean ME, Hans TS, Seidell JC . Impairment of health and quality of life using new US federal guidelines for the identification of Obesity. Arch Intern Med 1999; 159: 837–843.
Hakim Z, Wolf, Garrison L . Estimating the effect of changes in body mass index on health state preferences. Pharmacoeconomics 2002; 20: 393–404.
Hauptman J, Lucas C, Boldrin MN, Collins H, Segel KR . Orlistat in the long term treatment of obesity in primary care settings. Arch Family Med 2000; 9: 160–167.
Torrance GW . Social preferences for health states: an empirical evaluation of three measurement techniques. Socioeconom Plann Sci 1976; 10: 129–136.
Field AE, Coakley EA, Must A, Spadano JL, Laird N, Kostz WH, Rimm E, Colditz GA . Impact of overweight on the risk of developing common chronic diseases during a 1-year period. Arch Intern Med 2001; 161: 1581–1586.
MIMS: The Monthly index of medical specialities. Dec 2003. Published by medical publications (Ireland).
Diabetes Service Development Group. Diabetes Care: securing the future Report of the Diabetes Service Development Group, Report compiled by Ms Anna Clarke and edited by: Dr John Barragry, Ms Rita Forde, Dr Emer Shelley, Prof TJ McKenna and Mr Ronan Quirke. 2002, Chapter 13.
NICE Guidance on Orlistat 2001. Available at website www.nice.org.uk.
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 diabetes 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.
A systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. Available on the NICE website at http://www.nice.org.uk/pdf/orlistathta.pdf (accessed April 2004).
Devlin N, Parkin D . Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ 2004; 13: 437–452.
Expert opinion regarding experience with NICE in UK. See website at www.nice.org.uk.
Murphy JFA . The need for an obesity taskforce. Irish Med J 2001; 94: 68. Available at website www.imj.ie (accessed April 2004).
Roche EF . Childhood obesity–why should we be worried? Irish Med J 2003; 96: 100–102. Available at website www.imj.ie (accessed April 2004).
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Dr Lacey is a consultant to Roche Ireland.
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Lacey, L., Wolf, A., O'Shea, D. et al. Cost-effectiveness of orlistat for the treatment of overweight and obese patients in Ireland. Int J Obes 29, 975–982 (2005). https://doi.org/10.1038/sj.ijo.0802947
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DOI: https://doi.org/10.1038/sj.ijo.0802947
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