QVIA, Basel, Switzerland.
QVIA Mississauga, Mississauga, ON, Canada.
Int J Obes (Lond). 2024 May;48(5):683-693. doi: 10.1038/s41366-024-01467-w. Epub 2024 Jan 31.
OBJECTIVES: This study aimed to assess the cost-effectiveness of weight-management pharmacotherapies approved by Canada Health, i.e., orlistat, naltrexone 32 mg/bupropion 360 mg (NB-32), liraglutide 3.0 mg and semaglutide 2.4 mg as compared to the current standard of care (SoC). METHODS: Analyses were conducted using a cohort with a mean starting age 50 years, body mass index (BMI) 37.5 kg/m, and 27.6% having type 2 diabetes. Using treatment-specific changes in surrogate endpoints from the STEP trials (BMI, glycemic, blood pressure, lipids), besides a network meta-analysis, the occurrence of weight-related complications, costs, and quality-adjusted life-years (QALYs) were projected over lifetime. RESULTS: From a societal perspective, at a willingness-to-pay (WTP) threshold of CAD 50 000 per QALY, semaglutide 2.4 mg was the most cost-effective treatment, at an incremental cost-utility ratio (ICUR) of CAD 31 243 and CAD 29 014 per QALY gained versus the next best alternative, i.e., orlistat, and SoC, respectively. Semaglutide 2.4 mg extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg and remained cost-effective both under a public and private payer perspective. Results were robust to sensitivity analyses varying post-treatment catch-up rates, longer treatment durations and using real-world cohort characteristics. Semaglutide 2.4 mg was the preferred intervention, with a likelihood of 70% at a WTP threshold of CAD 50 000 per QALY gained. However, when the modeled benefits of weight-loss on cancer, mortality, cardiovascular disease (CVD) or osteoarthritis surgeries were removed simultaneously, orlistat emerged as the best value for money compared with SoC, with an ICUR of CAD 35 723 per QALY gained. CONCLUSION: Semaglutide 2.4 mg was the most cost-effective treatment alternative compared with D&E or orlistat alone, and extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg. Results were sensitive to the inclusion of the combined benefits of mortality, cancer, CVD, and knee osteoarthritis.
目的：本研究旨在评估加拿大卫生部批准的体重管理药物疗法（奥利司他、纳曲酮 32mg/安非他酮 360mg[NB-32]、利拉鲁肽 3.0mg 和司美格鲁肽 2.4mg）与当前标准治疗（SoC）相比的成本效益。
方法：使用起始年龄为 50 岁、体重指数（BMI）为 37.5kg/m²和 27.6%患有 2 型糖尿病的队列进行分析。使用 STEP 试验中替代终点的特定治疗变化（BMI、血糖、血压、血脂），以及网络荟萃分析，预测终生体重相关并发症、成本和质量调整生命年（QALY）的发生情况。
结果：从社会角度来看，在支付意愿（WTP）阈值为 CAD 50000 元/QALY 的情况下，司美格鲁肽 2.4mg 是最具成本效益的治疗方法，增量成本效用比（ICUR）分别为 CAD 31243 和 CAD 29014 元/QALY，优于下一个最佳替代方案，即奥利司他和 SoC。司美格鲁肽 2.4mg 优于其他药物疗法，如 NB-32 或利拉鲁肽 3.0mg，并且在公共和私人支付者的角度下仍然具有成本效益。在改变治疗后追赶率、延长治疗时间和使用真实世界队列特征的敏感性分析中，结果仍然稳健。在支付意愿阈值为 CAD 50000 元/QALY 的情况下，司美格鲁肽 2.4mg 的可能性为 70%，是首选的干预措施。然而，当同时去除体重减轻对癌症、死亡率、心血管疾病（CVD）或骨关节炎手术的建模益处时，奥利司他与 SoC 相比成为性价比最高的选择，ICUR 为 CAD 35723 元/QALY。
结论：与 D&E 或奥利司他单独治疗相比，司美格鲁肽 2.4mg 是最具成本效益的治疗选择，并且优于其他药物疗法，如 NB-32 或利拉鲁肽 3.0mg。结果对死亡率、癌症、CVD 和膝关节骨关节炎的综合益处的纳入较为敏感。
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