Treatment of Obesity: Pharmacotherapy trends in the United States from 1999 to 2010

Abstract

cation prescriptions; reliance on pharmacotherapy in obesity treatment; the odds of a specific patient's being prescribed antiobesity medication; and consistency of prescribing with the 1998 obesity guidelines. METHODS: Data for adult patients were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, and were appropriately weighted to produce national estimates of prescribing patterns. Obesity was identified using ICD-9 codes, BMI values, and a chronic-obesity-condition variable. For obese patients, a logistic regression model was estimated to determine the odds of receiving pharmacotherapy. RESULTS: The number of outpatient visits with any mention of an antiobesity medication increased from 6.5 million from 1999-2001 to 13.0 million from 2008-2010. Only 2.0% of the 987 million obese-patient visits from 2005-2010 mentioned an antiobesity drug. Additionally, there were 6.5 million visits by nonobese patients with an antiobesity drug mention. Visits made by females (OR = 2.89; 95% CI: 2.08-4.03), by white patients (OR = 1.55; 95% CI: 1.08-2.24), by younger adults (OR = 1.71; 95% CI: 1.34-2.20), and in the South (OR = 3.39; 95% CI: 1.49-7.72) were more likely to involve an antiobesity drug prescription. CONCLUSIONS: Pharmacotherapy has been underutilized as a treatment option for obese patients. Only 1 in 50 patients is receiving a prescription for an antiobesity medication. Prescribing regulations and drug safety concerns have clearly discouraged the use of pharmacotherapy. Moreover, in contrast to what the 1998 guidelines suggested, physicians have tended to prescribe antiobesity medications to self-paying young, white, females, many of whom lived in the South, and not all of whom were obese; they have tended not to prescribe them to patients with comorbidities like hypertension. OBJECTIVES:To determine the antiobesity-drug prescribing patterns of U.S. physicians over the last decade (1999-2010) by quantifying trends in antiobesity medi-

Low adoption of weight loss medications: A comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s

“…The adoption rate of SGLT2s was nearly exponential, while the adoption rate of new antiobesity pharmacotherapies was linear. Echoing the findings of Xia et al, the geographic distribution of dispensed antiobesity pharmacotherapies and SGLT2s match the geographic prevalence of obesity and diabetes . The specialties that are expected to treat obesity and diabetes (Family Medicine/General Practice, Internal Medicine, and Endocrinology) are the top prescribing medical specialties.…”

“…While new antiobesity pharmacotherapy wholesale acquisition costs are somewhat lower than that of SGLT2s, the lack of insurance coverage makes antiobesity pharmacotherapy far less affordable for most Americans. Antiobesity pharmacotherapies are either excluded from insurance formularies, thus limiting to those with the means of self‐pay, or require prior authorization , thus requiring significantly more physician and office staff time to prescribe. This is in contrast to SGLT2s, which are included in insurance formularies and, depending on the plan, are categorized as low as Tier 1, i.e., having the lowest copay available .…”

“…As of 2013, only 14 state Medicaid programs provided coverage for at least one antiobesity pharmacotherapy and all required prior authorization. Antiobesity pharmacotherapy is specifically excluded from Medicare Part D .…”

The Societal Value of Broader Access to Antiobesity Medications

“…Scenario 1 (status quo) represented current rates of obesity and diet and exercise among the population (Table ). We assumed no AOM use under the status quo because less than 2% of individuals eligible for AOM receive such therapies . In scenario 2 (15% uptake), we assumed that 15% of eligible treatment‐naïve individuals initiated treatment with currently available AOM for chronic weight management (i.e., liraglutide 3.0 mg, lorcaserin, phentermine/topiramate, and naltrexone/bupropion) in each model cycle starting in 2019.…”

“…Scenario 1 (status quo) represented current rates of obesity and diet and exercise among the population (Table 1). We assumed no AOM use under the status quo because less than 2% of individuals eligible for AOM receive such therapies (28,29). In scenario 2 (15% uptake), we assumed that (20,21,(30)(31)(32) from 2019 to 2023 and was increased to 14% beginning in the year 2023, consistent with existing evidence of next-generation AOM on the horizon (33).…”