Orlistat for the treatment of obesity: rapid review and cost‐effectiveness model

Abstract

The aim of this study is to clarify the potential benefits, disbenefits and costs of Orlistat for the treatment of obesity. The method was a search for relevant systematic reviews and randomized controlled trials, in Medline, Pre-Medline, Embase and the Cochrane Library, using Orlistat and its synonyms. Identified trials were appraised using a standard appraisal checklist and trial data were extracted for use in cost-effectiveness modelling. Three large multicentre, randomized placebo controlled trials were included in the rapid review. On average, Orlistat results in obese people losing an additional 3-4% of their initial body weight over diet alone during a 2 year period. There was no strong evidence that this short-term weight loss would have a longer-term impact on morbidity and mortality. The cost utility of Orlistat treatment was estimated at around 46,000 Pounds per Quality Adjusted Life Year gained (extreme values sensitivity analysis 14,000 Pounds to 132,000 Pounds). This rapid review raises some important questions about the potential value of Orlistat in the treatment of obesity. Further research is needed, not only to clarify the longer-term impact of Orlistat treatment, but also to uncover the longer-term impact on mortality and morbidity from short-term weight loss.

Utilities and disutilities for type 2 diabetes treatment-related attributes

“…Compared with the basic health state which was anchored to participants' current weight, otherwise identical health states with lower weight (I and J) had significantly higher utilities (increases of 0.02 and 0.03), whereas health states with higher weight (E and F) had significantly lower utilities (decreases of -0.04 and -0.07). This inverse relationship between weight and utility is consistent with findings from previous studies that assessed utilities of patients with type 2 diabetes [9,29,32,33] and obesity [60,[66][67][68]. These previous studies examined the relationship between patients' BMI and utility assessed with questionnaires, most commonly the EQ-5D or Quality of Well-Being Scale.…”

Clinical and economic considerations of antiobesity treatment: a review of orlistat

“…The costs per QALY gained for the EMEA criteria were £19,005 compared to £24,431 when NICE criteria were applied. Both of these results were better than a previous estimate of £45,881 per QALY,97 reflecting the more restrictive criteria for the continued use of orlistat, as well as taking into account that prescriptions were almost always provided by general practitioners rather than more expensive hospital specialists. The finding that EMEA criteria resulted in a more favorable estimate indicated that the NICE criteria may have narrowed the treatment population too far 96…”

Motivational interviewing for modifying diabetes risk: a randomised controlled trial

“…The NNT for 2 years to achieve 5% weight loss using orlistat is 6 (95% CI = 4 to 14), with an estimated treatment cost (at 2007 prices) of £1759 per patient. 30 noting that the present study did not set out to formally measure or compare cost-effectiveness, and these figures are presented mainly to contextualise this study as a lower-cost approach.…”