Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Abstract

ImportanceAlthough the American Academy of Pediatrics has recommended treatment with antiobesity drugs for adolescents, the cost-effectiveness of antiobesity drugs for this population is still unknown.ObjectiveTo quantify cost-effectiveness of different antiobesity drugs available for pediatric use.Design, Setting, and ParticipantsThis economic evaluation used a Markov microsimulation model with health states defined by obesity levels. Effectiveness was measured by quality-adjusted life-years (QALYs) and costs were calculated from third-party payer perspective, estimated in 2023 US dollars over a 10-year horizon. Data were obtained from the published literature.InterventionAntiobesity drugs orlistat, liraglutide, semaglutide, and phentermine-topiramate vs no treatment. Metformin hydrochloride and 2 types of bariatric surgical procedures (sleeve gastrectomy and gastric bypass) were considered in sensitivity analysis.Main Outcomes and MeasuresIncremental cost-effectiveness ratio.ResultsAmong the 4 antiobesity drugs currently approved for pediatric use, phentermine-topiramate was the most cost-effective with an incremental cost-effectiveness ratio of $93 620 per QALY relative to no treatment in this simulated cohort of 10 000 adolescents aged 12 to 17 years (mode, 15 years) with severe obesity (62% female). While semaglutide offered more QALYs than phentermine-topiramate, its higher cost resulted in an incremental cost-effectiveness ratio ($1 079 480/QALY) that exceeded the commonly used willingness-to-pay threshold of $100 000 to $150 000/QALY. Orlistat and liraglutide cost more and were less effective than phentermine-topiramate and semaglutide, respectively. Sleeve gastrectomy and gastric bypass were more effective than phentermine-topiramate but were also more costly, rendering them not cost-effective compared with phentermine-topiramate at the willingness-to-pay threshold of $100 000 to $150 000/QALY.Conclusions and RelevanceIn this economic evaluation of weight loss drugs for adolescents with severe obesity, we found phentermine-topiramate to be a cost-effective treatment at a willingness-to-pay threshold of $100 000 to $150 000/QALY. Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment.

Cost‐effectiveness analysis of individual‐level obesity treatment in paediatrics: A scoping review

“…Based on the current studies inclusion dates, and eligibility criteria, there were no studies assessing the cost‐effectiveness of obesity pharmacotherapy in this age group highlighting the need for additional investigation of individual level cost‐effectiveness analysis for obesity pharmacotherapy in youth 46 . However, recently, there were two studies published that reported the cost‐effectiveness of obesity pharmacotherapy in adolescents utilizing Markov microsimulation models with costs estimated from the health system perspective 47,48 . While these studies did not include individual level data, given the recent and pending regulatory approvals for multiple highly effective pharmacotherapies, such as the glucagon‐like‐1‐peptide agonist, the results were highly pertinent to the field of paediatric obesity medicine.…”

“…While these studies did not include individual level data, given the recent and pending regulatory approvals for multiple highly effective pharmacotherapies, such as the glucagon‐like‐1‐peptide agonist, the results were highly pertinent to the field of paediatric obesity medicine. The economic evaluation completed by Mital et al suggested that the phentermine‐topiramate combination agent was the most cost‐effective of all the available FDA approved medication for paediatric obesity due to the high cost of semaglutide despite it being more effective than phentermine‐topiramate in terms of weight loss 48 . Lim et al found that in an economic evaluation of 100,000 simulated adolescents with obesity, no obesity pharmacotherapy was cost effective after 2 years, however high dose phentermine‐topiramate was projected to be cost‐effective after 5‐years with an ICER of USD 56,876 per QALY gained 47 …”

Semaglutide for management of obesity in adolescents: efficacy, safety, and considerations for clinical practice

“…Mital and Nguyen used a Markov microsimulation model to perform an economic evaluation and determine the incremental cost-effectiveness ratio (ICER) of the four antiobesity drugs with current FDA approval for pediatric use (semaglutide, phentermine-topiramate, liraglutide, orlistat), with effectiveness measured using quality-adjusted life-years (QALYs) over a 10-year horizon. They found that although semaglutide led to more QALYs than phentermine-topiramate, due to semaglutide's high cost, phentermine-topiramate was most cost-effective (semaglutide ICER = $1079,480 per QALY and phentermine-topiramate ICER = $93 620 per QALY, vs. no treatment, for 12–17-year-old adolescents with severe obesity) [40 ▪▪ ]. In a similar economic evaluation, Lim and colleagues estimated the cost-effectiveness of semaglutide, mid- and top-dose phentermine-topiramate, and liraglutide, as an adjunct to lifestyle counseling vs. lifestyle counseling alone for adolescents with obesity.…”

GLP-1 Agonists for Obesity—Reply

“…In real-world settings, many patients continue GLP-1 therapy, with weight loss plateauing while drug costs continue. Two recent analyses, not funded by the manufacturer, calculated incremental costs per QALY for semaglutide of $351 000 to $508 000 for adults and more than $1 million for adolescents with obesity . All of these analyses accounted for multiple downstream complications of obesity and likely overestimate cost-effectiveness, given lower weight loss achieved in real-world settings compared with the trials…”