Bariatric treatments for adult obesity - Institute of Health Economics

study); and $16,384 in Finland, $18,486 in Germany, $14,476 in Switzerland, and $7439 in the UK(as shown in the Ara study). These studies achieved the consistent conclusion that addingsibutramine to LM was a cost-effective option, compared to LM alone.Ruof et al. 22 conducted a decision analytic model to evaluate the cost-effectiveness of orlistat incomparison with placebo for obese patients in Sweden and Switzerland with T2DM. This model wasconducted from a payers’ perspective over an11-year horizon. A meta-analysis was conducted topool results from even RCTs, including 1249 and 1230 patients in the orlistat and placebo groups,respectively. Patients with weight loss greater than 5% at 12 weeks would continue the treatment for1 year, while the treatment would be discontinued for those who failed to achieve a 5% weight loss.The economic analysis considered costs of medication and treatment for obesity- and diabetesrelatedmorbidities. Results indicated that the orlistat treatment was associated with $18,881 and$18,341, in Sweden and Switzerland respectively, per QALY gained. The study supported the use oforlistat for overweight and obese patients with T2DM.Lamotte et al. 23 constructed a Markov model to evaluate the cost-effectiveness of orlistat for obesepatients with T2DM, as compared to no treatment. The population was divided into four subgroups:patients with event-free profiles;patients with arterial hypertension but without hypercholesterolaemia at the beginning of thestudy;patients with hypercholesterolaemia but without arterial hypertension at the beginning of thestudy; patients with arterial hypertension and hypercholesterolaemia.The study adopted a payers’ perspective and was conducted over a 10-year horizon in Belgium. Thecosts included were of medications and obesity-related morbidity (including microvascularcomplications and macrovascular complications). Results indicated that, as compared to notreatment, the cost of orlistat per LY saved, for the above-listed subgroups, was $26,953, $9989,$9964, and $4669, respectively. The study concluded that orlistat was a cost-effective option for thetreatment of obese patients with T2DM.Malone et al. 24 used data from a RCT enrolling 501 patients to assess the cost-effectiveness ofsibutramine plus a WMP for the treatment of overweight and obese patients, as compared to aWMP alone. The patient population comprised individuals aged 18 years or older with a BMI ≥ 30kg/m 2 or a BMI between 27 and 29.9 kg/m 2 with one or more co-morbidities, including diabetes,hypertension, or hyperlipidaemia. The WMP was a physician-supervised, multidisciplinary program,including five monitored care visits and two education programs. The study was conducted from apayer’s perspective and the time horizon was 24 months (12 months before enrolment and 12months after enrolment). Cost categories included the costs of hospitalization, outpatient visits,physician visits, and prescription medications. Results showed that the weight loss at 12 months was13.7 pounds for sibutramine plus a WMP and five pounds for a WMP alone. Compared with WMPalone, the cost of sibutramine plus a WMP was $44 per pound lost. The study concluded that addingsibutramine to a WMP generated a significant weight loss but there were no savings in healthcarecosts, compare to a WMP alone.Bariatric treatments for adult obesity 167