In adolescents with severe obesity, phentermine-topiramate is a cost-effective treatment at a willingness-to-pay threshold of $100,000 to $150,000 per quality-adjusted life-year (QALY), researchers report. “Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment,” the authors conclude.
The cost-effectiveness analysis considered the antiobesity medications orlistat, liraglutide, semaglutide, and phentermine-topiramate versus no treatment in a Markov microsimulation model with health states defined by obesity levels. The perspective was that of a third-party payer, with a primary outcome of an incremental cost-effectiveness ratio tested using 2023 U.S. dollars analyzed over a 10-year horizon. Sensitivity analysis included metformin and bariatric surgery using sleeve gastrectomy and gastric bypass.
“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),” the authors write. “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.”