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. 2023 Oct 2;6(10):e2336400.
doi: 10.1001/jamanetworkopen.2023.36400.

Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Shweta Mital  1 , Hai V Nguyen  2
Affiliations

Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Shweta Mital et al. JAMA Netw Open. .

Abstract

Importance: Although 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.

Objective: To quantify cost-effectiveness of different antiobesity drugs available for pediatric use.

Design, setting, and participants: This 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.

Intervention: Antiobesity 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 measures: Incremental cost-effectiveness ratio.

Results: Among 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 relevance: In 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.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Transition Across Body Mass Index (BMI) States
Adolescent healthy weight indicates BMI (calculated as weight in kilograms divided by height in meters squared) between 5th and 85th percentile; adolescent overweight, BMI between 85th and 95th percentile; adolescent obesity, BMI above 95th percentile but below 120% of the 95th percentile or 35; adolescent severe obesity, BMI above 120% of the 95th percentile or 35; adult healthy weight, BMI less than 25; adult overweight, BMI 25 to 30; adult obesity 1, BMI 30 to 35; adult obesity 2, BMI 35 to 40; and adult obesity 3, BMI 40 and higher.
Figure 2.
Figure 2.. Sensitivity of Incremental Cost-Effectiveness Ratios to Model Inputs
BMI indicates body mass index; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years.
See this image and copyright information in PMC

Comment in

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