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Ara R, Blake L, Gray L, et al. What is the Clinical Effectiveness and Cost-Effectiveness of Using Drugs in Treating Obese Patients in Primary Care? A Systematic Review. Southampton (UK): NIHR Evaluation, Trials and Studies Coordinating Centre (UK); 2012 Feb. (Health Technology Assessment, No. 16.5.)

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What is the Clinical Effectiveness and Cost-Effectiveness of Using Drugs in Treating Obese Patients in Primary Care? A Systematic Review.

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7Conclusions

Currently, orlistat is the only licensed medication for the management of obesity. In clinical practice orlistat should be considered to aid weight reduction with lifestyle interventions in those individuals who have not been successful in reducing their weight with lifestyle alone.

Our MTC of anti-obesity treatments shows that all of the active treatments are effective at reducing weight and BMI. The economic results show that compared with placebo the treatments are all cost-effective when using a threshold of £20,000 per QALY and, within the limitations of the data available, sibutramine 15 mg dominates the other three interventions. However, if the proportion of patients who experienced a fatal adverse event was > 1.8% (1.5%, 1.0%) for sibutramine 15 mg (sibutramine 10 mg, rimonabant), the treatment would no longer be considered cost-effective when using a threshold of £20,000 per QALY.

Suggested research priorities

There are many avenues of further work that could be explored but which are beyond the scope of this project. Novel methods are now available to fully assess the inconsistencies within a network193 and could be used to explore the differences found between the pair-wise and MTC analyses. Meta-regression methods could also be used to look for effect modifiers, for example baseline weight might interact with the treatment effect seen. The effect of the level of publication bias on the results found could also be assessed. From a clinical point of view a long-term clinical trial of orlistat with a similar design to the SCOUT trial may be needed to detect long-term adverse events of this drug.

Given the high levels of variation in consistency and accuracy found in the BMI recordings from the GPRD data, it would be prudent to investigate and compare risk models based on more robust data obtained from observational studies. As discussed earlier, inclusion of ethnicity into risk models would allow further tailoring of subgroup risk profiles. Furthermore, unlimited computing resources would enable the investigation of joint models to model the repeated measures of BMI (with error) and the time-to-event processes simultaneously. Of course, as stated previously, such models may provide relatively small benefits.

In addition, clinical studies of at least 12 months' duration in subgroups with high prevalence rates of obesity would be informative for future economic evaluations, as would observational data describing the effect on BMI after cessation of treatment. Although this is the first evaluation to examine the comparative costs and benefits of the three interventions directly, given the growing prevalence of obesity, as evidence becomes available on new interventions in this area their cost-effectiveness should be compared to determine the optimal intervention.

© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK97597
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