The use of anti-obesity medications has become a subject of great interest and debate, with widespread media coverage and discussions surrounding their efficacy and safety. While the majority of this discourse has centered around adults, it is important to recognize that obesity affects a significant number of children and adolescents in the United States. In response to this growing concern, the American Academy of Pediatrics (AAP) recently released its first clinical practice guideline recommending the use of anti-obesity medications for adolescents aged 12 years and older. This article critically examines the cost-effectiveness of these medications in the treatment of obesity among adolescents, evaluating their potential benefits and limitations.
Cost-effectiveness analyses play a crucial role in comparing different interventions by assessing their relative costs and associated health outcomes. By using quality-adjusted life years (QALYs) as a measure, which considers both the quantity and quality of years lived, these analyses aim to determine the value of each intervention. In this study, published in JAMA Network Open, the authors utilized QALYs to evaluate the cost-effectiveness of lifestyle counseling alone and various anti-obesity medications for adolescents.
The study found that top-dose phentermine/topiramate emerged as the preferred and most cost-effective treatment option for adolescents with obesity. The analysis considered factors such as weight reduction and changes in quality of life to estimate the impact of each intervention. While semaglutide resulted in the greatest weight reduction, the higher cost of this medication deemed it less cost-effective compared to top-dose phentermine/topiramate.
To determine the cost-effectiveness of one intervention compared to another, the study employed an incremental cost-effectiveness ratio (ICER). In the United States, interventions with an ICER below $100,000 per QALY gained are typically considered cost-effective. The ICER for top-dose phentermine/topiramate was estimated to be $56,876 per QALY gained, making it a favorable option when compared to lifestyle counseling alone. In contrast, semaglutide had an ICER of $1.1 million per QALY gained, rendering it far less cost-effective in comparison.
While the study highlighted the potential cost-effectiveness of anti-obesity medications for adolescents within a short-term timeframe, it emphasized several limitations that must be considered. Long-term data on the use of these medications in adolescents is currently lacking, with clinical trials providing follow-up data for only approximately one year. As a result, the study relied on assumptions to project outcomes over a five-year period. Additionally, the possibility of weight regain following treatment discontinuation and the impact of anti-obesity medications on comorbidity development in adulthood were not thoroughly explored.
Despite the effectiveness of anti-obesity medications, one major barrier to their uptake is the high cost associated with them. Many state Medicaid plans do not cover these medications, and private insurance often imposes strict criteria for approval. Consequently, the high out-of-pocket costs act as deterrents for patients seeking early and aggressive treatment, as recommended by the AAP. It is crucial for patients to have easy and affordable access to these medications if we expect positive health outcomes to be achieved.
The cost-effectiveness of anti-obesity medications for adolescents presents a complex and multifaceted issue. While top-dose phentermine/topiramate appears to be the most cost-effective option based on the available evidence, further research and long-term studies are required to fully understand the efficacy and safety of these medications in the adolescent population. Additionally, the accessibility and affordability of these medications pose significant challenges that must be addressed to ensure equitable and effective treatment for adolescents with obesity. It is only through comprehensive analysis, consideration of limitations, and implementation of appropriate policies that we can optimize the use of anti-obesity medications in this vulnerable population.
Francesca Lim, MS, is a research analyst with HIRE at Columbia University Irving Medical Center.