UAB Diabetes Research Center, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
Analysis Group, Inc., Boston, Massachusetts, USA.
Popul Health Manag. 2023 Feb;26(1):72-82. doi: 10.1089/pop.2022.0227. Epub 2023 Feb 3.
This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort ( = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort ( = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
本研究调查了肥胖药物（AOM；奥利司他、利拉鲁肽、盐酸安非他酮缓释片/纳曲酮缓释片、纳曲酮/安非他酮缓释片）在参与美国退伍军人肥胖管理计划（MOVE！）的肥胖退伍军人中的临床和经济影响。研究人群从退伍军人事务部（VA）电子病历中确定（2010-2020 年）。在 AOM+MOVE！队列（n=3732，平均年龄 57 岁，79%为男性）中，在初始开具 AOM 后 6、12 和 24 个月，或在 MOVE！队列中（n=7883，平均年龄 58 岁，81%为男性）门诊或住院就诊的相应日期，评估肥胖的临床指标以及医疗资源的利用和成本。在指数后 6 个月，AOM+MOVE！队列的心血管代谢指标（如收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白 A1c）优于 MOVE！队列，这种趋势在 12 个月和 24 个月时仍然存在。与 MOVE！队列相比，AOM+MOVE！队列在 6、12 和 24 个月时体重下降 5%-10%、10%-15%和>15%的可能性更高，且体重指数更低。AOM+MOVE！队列的住院和急诊就诊次数也少于 MOVE！队列，这与包括住院费用在内的总医疗费用较低有关。这些结果表明，将 AOM 治疗与 MOVE！计划相结合，可能为 VA 网络带来长期成本节约，并为肥胖退伍军人带来显著的临床改善。
