Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents.
Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents.
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DOI：
10.1001/jamanetworkopen.2023.29178
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Hur, Chin
中科院分区：
文献类型：
--
作者：
Lim, Francesca;Bellows, Brandon K.;Tan, Sarah Xinhui;Aziz, Zainab;Baidal, Jennifer A. Woo;Kelly, Aaron S.;Hur, Chin
与单纯的生活方式咨询相比，在模拟队列中，利拉鲁肽、中剂量苯乙醇胺和托吡酯、最大剂量苯丙氨酸乙酯和托吡酯，或者在生活方式咨询的辅助下治疗青少年肥胖症是否具有成本效益？在这项包括10万名 ，000名模拟青少年的经济评估中，没有一种药物治疗在治疗13个月和2年后被估计为具有成本效益。5年后，预计最大剂量的芬太尼和托吡酯具有成本效益，每获得一个质量调整的生命年，增加的成本效益比为56 876美元。这项经济评估发现，5年后，在生活方式咨询的辅助下，最大剂量的芬太尼和托吡酯对青少年肥胖症患者的治疗是具有成本效益的。这项经济评估估计了在青少年肥胖患者中，生活方式咨询单独以及作为利拉鲁肽、中剂量芬太尼和托吡酯、最大剂量芬太尼和托吡酯或思马路德辅助治疗的成本效益。建议12岁及以上肥胖的青少年使用抗肥胖药物治疗。美国食品和药物管理局已经批准了几种用于青少年的药物，但最具成本效益的药物仍不清楚。目的：评价生活方式咨询作为利拉鲁肽、中剂量芬太尼和托吡酯(7.5 mg和托吡酯46 mg)、大剂量芬太尼和托吡酯(15 mg和92 mg托吡酯)或半谷氨酸在青少年肥胖患者中的成本-效果。这项经济评估使用了一个微观模拟模型来预测生活方式咨询单独和辅助利拉鲁肽、中剂量苯乙酸乙酯和托吡酯、最大剂量苯乙酸乙酯和托吡酯、或赛马路德13个月、2年和5年的健康和成本结果，这些结果被定义为初始体重指数( ；计算为体重(公斤)除以身高(米)的平方)。模型输入来自临床试验、出版的文献和国家来源。分析了2022年4月至2023年7月的数据。生活方式咨询单独和作为利拉鲁肽、中剂量芬太尼和托吡酯、最大剂量芬太尼和托吡酯或赛马路德的辅助。主要结果是质量调整寿命年(QALY)、成本(2022美元)和增量成本效益比(ICER)，未来成本和QALY每年贴现3.0%。如果ICER低于每QALY$100000 ，则该策略被认为是具有成本效益的。首选策略被确定为在成本效益的同时QALY增长最大的策略。采用单因素方差分析和概率灵敏度分析评定参数的不确定性。该模型模拟了100BMI000的15岁青少年，初始体重指数为37，其中58BMI000(58%)是女性 。在13个月和2年后，生活方式咨询被估计为首选策略。在5年内，最大剂量的芬太尼和托吡酯被预测为首选策略，与生活方式咨询相比，每QALY获得的ICER为56 876美元。赛马路德预计会产生最多的QALY，但与最大剂量的芬太尼和托吡酯相比，每QALY增加的ICER为110万美元。模型结果对生活方式咨询和大剂量芬太尼和托吡酯的减肥效果最敏感。在这项青少年肥胖药物治疗的经济评估中，估计5年后，在生活方式咨询的辅助下，最大剂量的芬太尼和托吡酯是有成本效益的。需要在青少年中进行长期临床试验，以充分评估药物治疗的结果，特别是成年后的结果。
Compared with lifestyle counseling alone, is liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide adjunct to lifestyle counseling cost-effective in treating obesity among adolescents in a simulated cohort? In this economic evaluation including 100 000 simulated adolescents, no pharmacotherapy was estimated to be cost-effective after 13 months and 2 years of treatment. After 5 years, top-dose phentermine and topiramate was projected to be cost-effective, with an incremental cost-effectiveness ratio of $56 876 per quality-adjusted life year gained. This economic evaluation found that top-dose phentermine and topiramate adjunct to lifestyle counseling was cost-effective for the treatment of obesity in adolescent patients after 5 years. This economic evaluation estimates the cost-effectiveness of lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate, maximum-dose phentermine and topiramate, or semaglutide among adolescent patients with obesity. Antiobesity pharmacotherapy is recommended for adolescents ages 12 years and older with obesity. Several medications have been approved by the US Food and Drug Administration for adolescent use, but the most cost-effective medication remains unclear. To estimate the cost-effectiveness of lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate (7.5 mg phentermine and 46 mg topiramate), top-dose phentermine and topiramate (15 mg phentermine and 92 mg topiramate), or semaglutide among adolescent patients with obesity. This economic evaluation used a microsimulation model to project health and cost outcomes of lifestyle counseling alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide over 13 months, 2 years, and 5 years among a hypothetical cohort of 100 000 adolescents with obesity, defined as an initial body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 37. Model inputs were derived from clinical trials, published literature, and national sources. Data were analyzed from April 2022 to July 2023. Lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide. The main outcome was quality-adjusted life years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted 3.0% annually. A strategy was considered cost-effective if the ICER was less than $100 000 per QALY gained. The preferred strategy was determined as the strategy with the greatest increase in QALYs while being cost-effective. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. The model simulated 100 000 adolescents at age 15 with an initial BMI of 37, of whom 58 000 (58%) were female. At 13 months and 2 years, lifestyle counseling was estimated to be the preferred strategy. At 5 years, top-dose phentermine and topiramate was projected to be the preferred strategy with an ICER of $56 876 per QALY gained vs lifestyle counseling. Semaglutide was projected to yield the most QALYs, but with an unfavorable ICER of $1.1 million per QALY gained compared with top-dose phentermine and topiramate. Model results were most sensitive to utility of weight reduction and weight loss of lifestyle counseling and top-dose phentermine and topiramate. In this economic evaluation of pharmacotherapy for adolescents with obesity, top-dose phentermine and topiramate as adjunct to lifestyle counseling was estimated to be cost-effective after 5 years. Long-term clinical trials in adolescents are needed to fully evaluate the outcomes of pharmacotherapy, especially into adulthood.
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DOI：
10.1056/nejmoa1506699
发表时间：
2016-01-14
期刊：
The New England journal of medicine
影响因子：
--
作者：
Inge TH;Courcoulas AP;Jenkins TM;Michalsky MP;Helmrath MA;Brandt ML;Harmon CM;Zeller MH;Chen MK;Xanthakos SA;Horlick M;Buncher CR;Teen-LABS Consortium
通讯作者：
Teen-LABS Consortium
DOI：
10.1038/ijo.2011.158
发表时间：
2012-06
期刊：
International journal of obesity (2005)
影响因子：
--
作者：
Astrup A;Carraro R;Finer N;Harper A;Kunesova M;Lean ME;Niskanen L;Rasmussen MF;Rissanen A;Rössner S;Savolainen MJ;Van Gaal L;NN8022-1807 Investigators
通讯作者：
NN8022-1807 Investigators
影响因子：
6.9
作者：
Gasoyan, Hamlet;Sarwer, David B.
通讯作者：
Sarwer, David B.
DOI：
10.1016/s1553-7250(12)38016-1
发表时间：
2012-03-01
影响因子：
2.3
作者：
Hug, Balthasar L.;Keohane, Carol;Bates, David W.
通讯作者：
Bates, David W.
DOI：
10.1016/s2213-8587(22)00047-x
发表时间：
2022-05
期刊：
The lancet. Diabetes & endocrinology
影响因子：
--
作者：
通讯作者：
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