OBJECTIVES: U.S. obesity prevalence is among the highest in the world. Obesity is related to multiple comorbidities including cardiovascular diseases and diabetes. With the aim of elucidating the most cost-effective treatment for weight loss, we conducted a cost-effectiveness model comparing indicated pharmacologic treatments for obesity.

METHODS: A decision-analytic Markov model was developed from a U.S. healthcare system payer perspective comparing semaglutide, liraglutide, naltrexone plus bupropion (NpB) and phentermine plus topiramate (PpT). The population of interest included individuals of 45 years or older using national estimates of BMI distribution from NHANES (mean BMI 37.1, SD=4.9 and 36.8, SD=4.9 women and men, respectively). The model incorporates the risk of cardiovascular complications (acute myocardial infarction, coronary heart disease, congestive heart failure, stroke) and diabetes. The primary health states included are BMI<25 (normal), BMI 25-30 (overweight) and BMI>=30 (obese). BMI specific utility values and disutilities for cardiovascular and diabetes were used to calculate quality adjusted-life-years (QALYs). Endpoints included costs, QALYs, and incremental cost‐effectiveness ratios (ICERs) with a willingness‐to‐pay (WTP) threshold of $150,000/QALY. Results were analyzed at a life time horizon and a 3% discount rate. Probabilistic sensitivity analysis was conducted.

RESULTS: PpT had the lowest cost ($94,252) followed by NpB ($94,280), liraglutide ($325,694) and semaglutide ($431,632). Semaglutide and liraglutide had the highest effectiveness with 30.564 and 30.451 QALYs respectively. PpT and NpB had 30.376 and 30.316 QALYs, respectively. Among the four obesity treatments, PpT was the most cost-effective strategy. The ICER was $1,794,700 per QALY compare to semaglutide. The cost-effectiveness acceptability curve indicated there was no WTP values where other therapies had a higher probability of being cost-effective than PpT.

CONCLUSIONS: This analysis suggests that among pharmacological treatments for obesity, PpT has the lowest cost and provides nearly as many QALYs as liraglutide and semaglutide, and more than NpB.