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Economic Evaluation of Orlistat in Overweight and Obese Patients with Type 2 Diabetes Mellitus

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Abstract

Objective: To estimate the economic value of pharmacological treatment of type 2 diabetes mellitus in overweight and obese patients using orlistat in addition to standard diabetes therapy (i.e., a sulphonlyurea, metformin or insulin) and weight management strategies as compared with standard diabetes therapy and weight management strategies alone in a US-based healthcare setting. The perspective of the study was from the viewpoint of a US healthcare provider.

Design and setting: Markov state transition model simulating diabetes-related complications and mortality for a period of 11 years. Patients were modelled to continue orlistat therapy for a 52-week period, assuming a 3-year period of weight regain where after 3 years bodyweight would match that of the placebo group. The impact of orlistat on glycosylated haemoglobin (HbA1c) values was evaluated directly using data from four randomised, placebo-controlled, 1-year trials of orlistat in overweight or obese adults with type 2 diabetes who also received standard diabetes pharmacotherapy and intensive lifestyle modification. Incidence rates of micro- and macrovascular complications associated with type 2 diabetes and the estimated relative reduction in incidence rates associated with a decrease in mean updated HbA1C values were derived from the United Kingdom Prospective Diabetes Study (UKPDS) estimates for a reference population of male patients, 52 years of age.

US cost estimates were derived from published sources and presented in 2001 US dollars. Discounting of 3% was applied. Probabilistic sensitivity analysis was applied to evaluate the robustness of the results of the persistence of the effect of orlistat after treatment.

Main outcome measures: Average costs and event-free life-years gained during the 11-year period expressed as the incremental costs divided by the incremental gain in life expectancy.

Results: Treatment with orlistat, 120mg three times daily, increased event-free life expectancy by 0.13 years over an 11-year period. Average treatment costs were estimated to be $US19 987 in the orlistat group compared with $US18 865 in the group that received diabetes medication and weight management alone. This translated into a cost-effectiveness ratio of $US8327 per event-free life-year gained.

Conclusion: Adding orlistat as a pharmacological treatment to conventional diabetes and weight management approaches seems to be a cost-effective treatment option for overweight and obese patients with type 2 diabetes.

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Acknowledgements

Dr Maetzel and Dr Wolf had a consultancy relationship with Roche Pharmaceuticals Inc. during execution of this project. Dr Ruof and Ms Covington are employees of Roche Pharmaceuticals Inc. This research was supported by a grant from Roche Pharmaceuticals, Switzerland.

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Authors and Affiliations

  1. University Health Network Research Institute and Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Andreas Maetzel

  2. Health Services Research Unit, Department of Rheumatology, Center of Internal Medicine, Hannover Medical School, Hannover, Germany

    Jörg Ruof

  3. Health Economics Department, Roche Pharmaceuticals, Basel, Switzerland

    Jörg Ruof

  4. Medical Outcomes Research and Economics, Medical Science Department, Hoffman-La Roche Pharmaceuticals, Nutley, New Jersey, USA

    Melva Covington

  5. Department of Health Evaluation Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA

    Anne Wolf

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  1. Andreas Maetzel
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  2. Jörg Ruof
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  4. Anne Wolf
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Correspondence to Andreas Maetzel.

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Maetzel, A., Ruof, J., Covington, M. et al. Economic Evaluation of Orlistat in Overweight and Obese Patients with Type 2 Diabetes Mellitus. Pharmacoeconomics 21, 501–512 (2003). https://doi.org/10.2165/00019053-200321070-00005

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