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Haridoss M, Sasidharan A, Kumar S, Rajsekar K, Venkataraman K, Bagepally BS. Cost-Utility Analysis of TNF-α Inhibitors, B Cell Inhibitors, and JAK Inhibitors Versus csDMARDs for Rheumatoid Arthritis Treatment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00898-w. [PMID: 38951442 DOI: 10.1007/s40258-024-00898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a progressive and debilitating disease, causing persistent joint pain that limits daily activities requiring long-term treatment. Newer targeted therapies expand RA treatment options, but their high cost necessitates a focus on cost effectiveness. To address this, we aim to conduct a cost-utility analysis of these newer RA pharmacotherapies to support evidence-based policy decision-making. METHODS We analyzed the cost-utility of sequential treatment with TNF-α, B cell and JAK-inhibitors compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) for RA treatment in methotrexate (MTX) nonresponders. We used a Markov model with lifetime horizon and 6-month cycles from an Indian health system perspective. Costs (INR 2022) and quality-adjusted life years (QALYs) were used to determine the incremental cost-effectiveness ratios (ICERs) at a cost-effectiveness threshold of India's gross domestic product (GDP) per capita (2022). We assessed uncertainty using univariate, probabilistic sensitivity, and scenario analyses. RESULTS Despite additional QALYs, TNF-α, B cell, and JAK inhibitors were not cost-effective for treating moderate-to-severe patients with RA unresponsive to csDMARDs (including MTX) in India, as increased costs outweighed their clinical benefits. ICERs ranged from 10,46,206 to 31,09,207 Indian Rupees in the base case analysis, exceeding three times India's GDP per-capita [approximately USD $13,287 to $39,487 and GBP £10,776 to £32,025]. Sensitivity analyses confirmed the results' robustness. Scenario analysis suggested that a cost reduction of over 75% in drug prices could make most of the interventions cost effective compared with csDMARDs. CONCLUSIONS TNF-α, B cell, and JAK-inhibitors are not cost-effective compared with csDMARDs for patients with RA who have not responded to MTX in India at the current prices. Cost-effectiveness estimates were highly influenced by drug pricing variations. Therefore, reducing the prices of these interventions could enhance affordability, potentially leading to their inclusion in publicly funded health programs.
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Affiliation(s)
- Madhumitha Haridoss
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
- Division of Medical Research, SRM Medical College, Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur, 603203, India
| | - Akhil Sasidharan
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Sajith Kumar
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India
| | - Kavitha Rajsekar
- Health Technology Assessment in India (HTAIn) Secretariat, Department of Health Research, MoHFW, GOI, New Delhi, India
| | | | - Bhavani Shankara Bagepally
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, R-127, Tamil Nadu Housing Board, Phase I and II, Ayapakkam, Chennai, 600077, India.
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Wright DR, Batista M, Wrightson T. #SharingHEOR: Developing Modern Media for Communication and Dissemination of Health Economics and Outcomes Research. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:447-455. [PMID: 38427216 DOI: 10.1007/s40258-023-00863-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 03/02/2024]
Abstract
Questions regarding the effectiveness and safety of health interventions and allocation of health care resources are frequently discussed in mainstream and social media. Additionally, government and foundation funders are increasingly mandating that results be disseminated to the lay public and patients may benefit from being able to digest scientific research regarding their health conditions. Therefore, it is important to widely disseminate and clearly communication health economics and outcomes research (HEOR) findings to a range of interested parties. Digital media features such as graphical or visual abstracts, infographics and videos are informative and add value to research articles by improving reader engagement with articles, potentially increasing their impact, and allowing results to be more widely disseminated. However, use of novel digital media for research dissemination has been relatively limited to date. In this article, we discuss the rationale for developing novel media to communicate and disseminate research findings and offer practical advice for doing so. We conclude by outlining a future agenda for research regarding HEOR communication and dissemination.
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Affiliation(s)
- Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401E, Boston, MA, 02215, USA.
| | - Mikaela Batista
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401E, Boston, MA, 02215, USA
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Muchadeyi MT, Hernandez-Villafuerte K, Di Tanna GL, Eckford RD, Feng Y, Meregaglia M, Peasgood T, Petrou S, Ubels J, Schlander M. Quality Appraisal in Systematic Literature Reviews of Studies Eliciting Health State Utility Values: Conceptual Considerations. PHARMACOECONOMICS 2024; 42:767-782. [PMID: 38551803 PMCID: PMC11180162 DOI: 10.1007/s40273-024-01365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The increasing number of studies that generate health state utility values (HSUVs) and the impact of HSUVs on cost-utility analyses make a robust tailored quality appraisal (QA) tool for systematic reviews of these studies necessary. OBJECTIVE This study aimed to address conceptual issues regarding QA in systematic reviews of studies eliciting HSUVs by establishing a consensus on the definitions, dimensions and scope of a QA tool specific to this context. METHODS A modified Delphi method was used in this study. An international multidisciplinary panel of seven experts was purposively assembled. The experts engaged in two anonymous online survey rounds. After each round, the experts received structured and controlled feedback on the previous phase. Controlled feedback allowed the experts to re-evaluate and adjust their positions based on collective insights. Following these surveys, a virtual face-to-face meeting was held to resolve outstanding issues. Consensus was defined a priori at all stages of the modified Delphi process. RESULTS The response rates to the first-round and second-round questionnaires and the virtual consensus meeting were 100%, 86% and 71%, respectively. The entire process culminated in a consensus on the definitions of scientific quality, QA, the three QA dimensions-reporting, relevance and methodological quality-and the scope of a QA tool specific to studies that elicit HSUVs. CONCLUSIONS Achieving this consensus marks a pivotal step towards developing a QA tool specific to systematic reviews of studies eliciting HSUVs. Future research will build on this foundation, identify QA items, signalling questions and response options, and develop a QA tool specific to studies eliciting HSUVs.
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Affiliation(s)
- Muchandifunga Trust Muchadeyi
- Division of Health Economics, German Cancer Research Centre (DKFZ) Foundation under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karla Hernandez-Villafuerte
- Division of Health Economics, German Cancer Research Centre (DKFZ) Foundation under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care (DEASS), University of Applied Sciences and Arts of Southern Switzerland, Manno, Lugano, Switzerland
- The George Institute for Global Health, University of New South Wales (UNSW Sydney), Sydney, NSW, Australia
| | - Rachel D Eckford
- Division of Health Economics, German Cancer Research Centre (DKFZ) Foundation under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Yan Feng
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Tessa Peasgood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jasper Ubels
- Division of Health Economics, German Cancer Research Centre (DKFZ) Foundation under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Centre (DKFZ) Foundation under Public Law, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
- Alfred Weber Institute for Economics (AWI), University of Heidelberg, Heidelberg, Germany.
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Thangamma Ag M, Vidyadharan B, Daniel RP, Sirur A, Kumar P, Thunga P G, Gopal Poojari P, Rashid M, Mukherjee N, Bhattacharya P, John D. Cost and cost-effectiveness of treatments for rheumatic heart disease in low- and middle-income countries: a systematic review protocol. JBI Evid Synth 2024:02174543-990000000-00323. [PMID: 38932504 DOI: 10.11124/jbies-23-00246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This review will synthesize studies on costs, the impact of these costs, and the cost-effectiveness of treatments for rheumatic heart disease (RHD) in low- and middle-income countries. INTRODUCTION RHD incurs high costs owing to its clinical complexity, surgical treatments, and prolonged hospital stays. Thus, the disease has a substantial economic impact on the health system, patients, and their families. No systematic review on economic evidence of treatments for RHD has been published to date. INCLUSION CRITERIA This review will consider all cost and cost-effectiveness studies on RHD treatments for children and young adults (5─30 years), residing in low- and middle-income countries. METHODS The review will follow the JBI methodology for systematic reviews of economic evaluation evidence. The search strategy will locate published and unpublished studies in English. Systematic searches will be conducted in MEDLINE (PubMed), MEDLINE (Ovid), Embase (Ovid), Scopus, CINAHL (EBSCOhost), National Health Service Economic Evaluation Databases, Pediatric Economic Database Evaluation, and Cost-Effectiveness Analysis Registry. Two independent reviewers will screen titles and abstracts, followed by a full-text review based on the inclusion criteria. Data will be extracted using a modified JBI data extraction form for economic evaluations. JBI's Dominance Ranking Matrix for economic evaluations will be used to summarize and compare the results of cost and cost-effectiveness studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of economic evidence for outcomes related to resource use. REVIEW REGISTRATION NUMBER PROSPERO CRD42023425850.
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Affiliation(s)
- Mona Thangamma Ag
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavya Vidyadharan
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Roshan P Daniel
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Andria Sirur
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Girish Thunga P
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nirmalya Mukherjee
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Paramita Bhattacharya
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda, Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
| | - Denny John
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliate Centre, Centre for Public Health Research, Manbhum Ananda, Ashram Nityananda Trust (MANT), Kolkata, West Bengal, India
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Harvard S. Making Decision Models Fit for Purpose: The Importance of Ensuring Stakeholder Involvement. PHARMACOECONOMICS 2024; 42:249-252. [PMID: 38236547 DOI: 10.1007/s40273-023-01348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Stephanie Harvard
- Division of Respiratory Medicine, University of British Columbia (UBC), Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Legacy for Airway Health, Vancouver Coastal Health Research Institute, Robert H.N. Ho Research Centre, 2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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Xie F, Shemilt I, Vale L, Ruiz F, Drummond MF, Lord J, Herrmann KH, Rojas MX, Zhang Y, Canelo-Aybar C, Alonso-Coello P, Shamliyan T, Schünemann HJ. GRADE guidance 23: considering cost-effectiveness evidence in moving from evidence to health-related recommendations. J Clin Epidemiol 2023; 162:135-144. [PMID: 37597696 DOI: 10.1016/j.jclinepi.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/28/2023] [Accepted: 08/02/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND This is the 23rd in a series of articles describing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the certainty of evidence and strength of recommendations for systematic reviews, health technology assessments, and clinical guideline development. OBJECTIVES We outline how resource utilization and cost-effectiveness analyses are integrated into health-related recommendations, using the GRADE Evidence to Decision (EtD) frameworks. STUDY DESIGN AND SETTING Through iterative discussions and refinement, in-person, and online meetings, and through e-mail communication, we developed draft guidance to incorporate economic evidence in the formulation of health-related recommendations. We developed scenarios to operationalize the guidance. We presented a summary of the results to members of the GRADE Economic Evaluation Project Group. RESULTS We describe how to estimate the cost of preventing (or achieving) an event to inform assessments of cost-effectiveness of alternative treatments, when there are no published economic evaluations. Evidence profiles and Summary of Findings tables based on systematic reviews of cost-effectiveness analyses can be created to provide top-level summaries of results and quality of multiple published economic evaluations. We also describe how this information could be integrated in GRADE's EtD frameworks to inform health-related recommendations. Three scenarios representing various levels of available cost-effectiveness evidence were used to illustrate the integration process. CONCLUSION This GRADE guidance provides practical information for presenting cost-effectiveness data and its integration in the development of health-related recommendations, using the EtD frameworks.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Faculty of Health Sciences, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.
| | - Ian Shemilt
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; EPPI-Centre, University College London, 10 Woburn Square, London, WC1H 0NR, United Kingdom
| | - Luke Vale
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Health Economics Group, Population Health Sciences Institute, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Francis Ruiz
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Michael F Drummond
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Centre for Health Economics, University of York, Alcuin 'A' Block, Heslington, York YO10 5DD, United Kingdom
| | - Joanne Lord
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; Southampton Health Technology Assessments Centre, University of Southampton, 1st Floor, Epsilon House, Enterprise Road Southampton Science Park, Southampton, SO16 7NS, United Kingdom
| | - Kirsten H Herrmann
- Campbell & Cochrane Economics Methods Group, Newcastle upon Tyne, UK; ResearchGCP, Dunantstr.5, 85521 Ottobrunn, Germany
| | - María Ximena Rojas
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, (IIB Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Tatyana Shamliyan
- American College of Physicians, 190 N Independence Mall West, Philadelphia, PA, USA, 19106
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milano, Italy.
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Wright DR, Luviano A, Skelton JA. Interpreting Cost-Effectiveness Analyses of Anti-Obesity Medications for the Treatment of Adolescent Obesity-Reading the Tea Leaves. JAMA Netw Open 2023; 6:e2329422. [PMID: 37651147 DOI: 10.1001/jamanetworkopen.2023.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Andrea Luviano
- Interfaculty PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Lim F, Bellows BK, Tan SX, Aziz Z, Woo Baidal JA, Kelly AS, Hur C. Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents. JAMA Netw Open 2023; 6:e2329178. [PMID: 37651143 PMCID: PMC10472196 DOI: 10.1001/jamanetworkopen.2023.29178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/09/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Antiobesity pharmacotherapy is recommended for adolescents ages 12 years and older with obesity. Several medications have been approved by the US Food and Drug Administration for adolescent use, but the most cost-effective medication remains unclear. Objective To estimate the cost-effectiveness of lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate (7.5 mg phentermine and 46 mg topiramate), top-dose phentermine and topiramate (15 mg phentermine and 92 mg topiramate), or semaglutide among adolescent patients with obesity. Design, Setting, and Participants This economic evaluation used a microsimulation model to project health and cost outcomes of lifestyle counseling alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide over 13 months, 2 years, and 5 years among a hypothetical cohort of 100 000 adolescents with obesity, defined as an initial body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 37. Model inputs were derived from clinical trials, published literature, and national sources. Data were analyzed from April 2022 to July 2023. Exposures Lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide. Main Outcomes and Measures The main outcome was quality-adjusted life years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted 3.0% annually. A strategy was considered cost-effective if the ICER was less than $100 000 per QALY gained. The preferred strategy was determined as the strategy with the greatest increase in QALYs while being cost-effective. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Results The model simulated 100 000 adolescents at age 15 with an initial BMI of 37, of whom 58 000 (58%) were female. At 13 months and 2 years, lifestyle counseling was estimated to be the preferred strategy. At 5 years, top-dose phentermine and topiramate was projected to be the preferred strategy with an ICER of $56 876 per QALY gained vs lifestyle counseling. Semaglutide was projected to yield the most QALYs, but with an unfavorable ICER of $1.1 million per QALY gained compared with top-dose phentermine and topiramate. Model results were most sensitive to utility of weight reduction and weight loss of lifestyle counseling and top-dose phentermine and topiramate. Conclusions and Relevance In this economic evaluation of pharmacotherapy for adolescents with obesity, top-dose phentermine and topiramate as adjunct to lifestyle counseling was estimated to be cost-effective after 5 years. Long-term clinical trials in adolescents are needed to fully evaluate the outcomes of pharmacotherapy, especially into adulthood.
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Affiliation(s)
- Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Brandon K. Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sarah Xinhui Tan
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Zainab Aziz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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