title: A health economic model to assess the long-term effects and cost-effectiveness of orlistat in obese type 2 diabetic patients.
abstract: OBJECTIVE
  Obesity is a common condition in type 2 diabetic patients. Treating obesity may enhance hypoglycemic treatment and contribute to the reduction of long-term microvascular and macrovascular complications. Orlistat reduces cardiovascular risk factors in obese type 2 diabetic patients. The objectives of this study were to estimate the long-term clinical consequences of this weight loss and the resulting cost-effectiveness of treating obese type 2 diabetic patients with orlistat.
  
  
  METHODS
  A Markov model was developed to predict, over a 10-year period, the complication rates and mortality with and without a 2-year orlistat treatment, assuming a 5-year catch-up period after treatment. A stepwise approach was used to obtain the clinical data. First, the impact of weight loss with orlistat on HbA(1c), blood pressure, and cholesterol was assessed; then, the impact on mortality and micro- and macrovascular complications of decreasing these risk factors was applied. Four subgroups were studied based on the presence of risk factors.
  
  
  RESULTS
  Cost-effectiveness varies between 3,462 Euro/life-year gained (LYG) for obese diabetic patients with hypertension and hypercholesterolemia and 19,986 Euro/LYG for obese diabetic patients without other risk factors. The latter result is not robust according to sensitivity analyses.
  
  
  CONCLUSIONS
  Our results suggest that orlistat is cost-effective in the management of obese type 2 diabetic patients, especially in those with the presence of hypercholesterolemia and/or hypertension. Evidence on longer-term benefits of orlistat (>2 years) will be of importance for future decision-making.
authors.affiliation: Health Economics and Disease Management, Brusselsteenweg 91, B-1860 Meise, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Aurelia
authors.initials: A
authors.lastname: Lefever
authors.forename: Myriam
authors.initials: M
authors.lastname: Nechelput
authors.forename: Johan
authors.initials: J
authors.lastname: Masure
mesh_terms: D019440:Anti-Obesity Agents / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000401:mortality; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000401:mortality*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D006973:Hypertension / Q000191:economics / Q000401:mortality; D007783:Lactones / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D017059:Models, Econometric; D009765:Obesity / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D000077403:Orlistat; D012307:Risk Factors; D013995:Time
chemical_list: D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat