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Weight Watchers, phentermine/topiramate best value in weight loss
A review of six weight-loss strategies showed that the lifestyle program Weight Watchers and the drug combination phentermine/topiramate were the most cost-effective strategies for nonsurgical weight loss.
Weight Watchers and phentermine/topiramate (Qsymia, Vivus) were more cost-effective than another lifestyle program, a popular meal replacement program and other weight-loss drugs, according to the data recently published in Obesity.
In an analysis of total weight lost compared with program costs, Eric Finkelstein, MD, of Duke-NUS Graduate Medical School, Singapore, and Eliza Kruger, MS, of Duke University Global Health Institute, reviewed 27 studies. Data were based on adults in studies with no less than 50% attrition, with a primary outcome of weight-loss results extending at least 1 year. All weight-loss strategies included in the study are currently approved and available for use in the United States.
Eric Finkelstein
Annual costs for the drug-based weight-loss methods in the studies were $1,336 for phentermine/topiramate; $1,518 for orlistat (Alli, GlaxoSmithKline); and $1,743 for lorcaserin hydrochloride (Belviq, Arena Pharmaceuticals).
Annual costs for the lifestyle programs were $377 for Weight Watchers and $682 for Vtrim.
The annual cost for the meal replacement program Jenny Craig was more than $2,500; the investigators attributed the high overall cost of this program to the relatively high cost of Jenny Craig food.
Cost per kilogram lost
A comparison of weight lost during the 1-year study period and the estimated annual cost allowed the investigators to calculate how much it cost a program participant to lose a single kilogram.
Weight Watchers cost approximately $155/kg lost, with a total weight loss of 2.4 kg at year end (95% CI, 1.8-3). Vtrim cost $213/kg, with an average of 3.2 kg lost at year end (95% CI, 1.4-4.9).
Phentermine/topiramate cost $204/kg, with 6.7 kg lost at year end (95% CI, 4.7-8.6). Orlistat cost $546 with 2.8 kg lost (95% CI, 2.4-3.2). Lorcaserin cost a comparable $545, for 3.2 kg lost (95% CI, 2.6-3.8) after 1 year.
Finding, funding best value
“The obesity epidemic is raising serious health and cost consequences, so employers and third-party payers are beginning to consider how to provide some coverage for commercial weight-loss programs,” Finkelstein said in a press release. “These results will help them make better purchasing decisions to maximize the health gains using available resources.”
The researchers also gauged value using quality-adjusted life years (QALYs). “Health policy makers do not understand value in terms of cost per kilogram lost, but if you tell them that an intervention improves QALYs at better than $50,000 per QALY saved, they recognize that as good value for money,” Finkelstein said.
At the recommended threshold of $50,000 per QALY saved, Weight Watchers was deemed optimal in 46% of simulations; phentermine/topiramate was considered optimal in 34% of scenarios.
“Looking at cost per weight lost or QALY saved, Weight Watchers looked best because it’s the least expensive. Qsymia also showed good value for money because the additional weight loss came at a fairly low cost,” Finkelstein said.
Disclosure: Finkelstein has been a paid consultant for Jenny Craig, Orexigen Therapeutics, Takeda, Vivus and Weight Watchers.