Hertzman Peter
Karolinska Institute, Stockholm, Sweden.
Pharmacoeconomics. 2005;23(10):1007-20. doi: 10.2165/00019053-200523100-00004.
To calculate the cost effectiveness (from the Swedish healthcare perspective) of orlistat plus diet for an obese and overweight population in a 1-year weight-management responder programme versus a 1-year weight-management programme based on diet only. As a reference, orlistat plus diet and diet only were also compared with a no-diet alternative.
Costs and effectiveness were calculated in a decision-tree model by means of Monte Carlo simulation. Efficacy was derived from a pooled analysis of the orlistat clinical trial programme. Acquisition costs for orlistat (euro, 2003 prices), healthcare costs for visits to doctors and dieticians related to weight management, and costs related to the difference in diabetes mellitus incidence between treatment arms were included in the analysis. The health benefit of temporary weight loss was measured in the number of quality-adjusted life-years (QALYs) gained.
The number of responding (those with >5% weight loss) patients at month 3 was almost twice as high with orlistat compared with diet only: 48.9% versus 26.3%. Responding orlistat patients had a weight loss of 15.5% at month 12 compared with 7.9% for all patients on diet only. The incremental cost-effectiveness ratio (ICER) per QALY gained versus diet only was estimated to be 13,125 euro for the average patient starting on orlistat. When orlistat was compared with no diet, the cost effectiveness was improved. However, comparing diet only with no diet gave a slightly higher ICER, indicating that orlistat had an extended dominance over the diet-only alternative.
Our estimates indicated that orlistat in a 12-month dietary responder programme increased the number of QALYs and reduced the cumulative incidence of diabetes compared with diet only. Patients starting on orlistat in addition to a dietary programme achieved an ICER that was similar to many other well accepted healthcare treatment programmes. In order to improve the precision of our calculations, we need to confirm the key assumptions regarding temporary weight loss and utility gains, and the relationship between temporary weight loss and diabetes, as well as other co-morbidities, and to have better knowledge of the long-term impact of weight-management programmes in clinical practice, such as changes in weight-controlling behaviours and sustainability of weight loss.
从瑞典医疗保健的角度,计算在一项为期1年的体重管理应答者计划中,奥利司他联合饮食对肥胖和超重人群的成本效益,与仅基于饮食的1年体重管理计划进行对比。作为参考,还将奥利司他联合饮食和仅饮食方案与不进行饮食的替代方案进行了比较。
通过蒙特卡洛模拟在决策树模型中计算成本和效益。疗效来自奥利司他临床试验项目的汇总分析。分析中纳入了奥利司他的购置成本(欧元,2003年价格)、与体重管理相关的看医生和营养师的医疗保健成本,以及各治疗组之间糖尿病发病率差异相关的成本。通过获得的质量调整生命年(QALY)数量来衡量短期体重减轻的健康益处。
在第3个月时,使用奥利司他的应答患者(体重减轻>5%)数量几乎是仅采用饮食方案患者的两倍:分别为48.9%和26.3%。在第12个月时,使用奥利司他的应答患者体重减轻了15.5%,而仅采用饮食方案的所有患者体重减轻了7.9%。对于开始使用奥利司他的普通患者,相对于仅采用饮食方案,每获得一个QALY的增量成本效益比(ICER)估计为13,125欧元。当将奥利司他与不进行饮食的方案进行比较时,成本效益有所提高。然而,仅将饮食方案与不进行饮食的方案进行比较时,ICER略高,这表明奥利司他相对于仅饮食方案具有更广泛的优势。
我们的估计表明,在为期12个月的饮食应答者计划中,与仅采用饮食方案相比,奥利司他增加了QALY数量并降低了糖尿病的累积发病率。除饮食计划外开始使用奥利司他的患者实现的ICER与许多其他广泛接受的医疗保健治疗方案相似。为了提高我们计算的准确性,我们需要确认关于短期体重减轻和效用增加、短期体重减轻与糖尿病以及其他合并症之间关系的关键假设,并更好地了解体重管理计划在临床实践中的长期影响,如体重控制行为的变化和体重减轻的可持续性。