Cost-utility analysis of rimonabant in the treatment of obesity.
OBJECTIVE
To estimate the incremental cost-utility ratio (ICUR) of rimonabant 20 mg/day in the treatment of obesity from a third-party payer's perspective.


METHODS
Pooled data from three randomized clinical trials were used to develop a decision tree with five treatment alternatives: 1- and 2-year treatment with rimonabant, 2-year placebo, 1-year rimonabant followed by 1-year placebo, and no treatment. All alternatives, except no treatment, were accompanied by lifestyle interventions. Treatment benefits included gains in quality-adjusted life-years (QALYs) and reduced incidence of type-2 diabetes mellitus and coronary heart disease (CHD). Drug acquisition cost was based on the average wholesale price of a comparator drug minus 15%. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results.


RESULTS
One-year rimonabant and 1-year rimonabant followed by placebo were extensively dominated. Rimonabant for 2 years showed an average weight reduction of 8.49 kg, a body mass index reduction of 2.98 kg/m(2) and reduced waist circumference by 8.24 cm (placebo: 3.55 kg, 1.22 kg/m(2), 4.18 cm). Two-year rimonabant was associated with a relative reduction in the 5-year incidence of CHD by 7.15% and of diabetes by 9.28%. Incremental benefits (costs) were 0.0984 QALYs ($5209) compared to no treatment and 0.0581 QALYs ($4182) compared to placebo, producing ICURs of $52,936/QALY (95% confidence interval $39K-$69K) and $71,973/QALY ($51K-$98K), respectively.


CONCLUSIONS
Rimonabant combined with lifestyle interventions has the potential to decrease the rate of obesity-related comorbidities and improve health-related quality of life, albeit at considerable cost.
Hampp
Christian
C
Pharmacy Health Care Administration, College of Pharmacy, University of Florida, Gainesville, FL 32610-0496, USA. champp@ufl.edu
Hartzema
Abraham G
AG
Kauf
Teresa L
TL
D019440:Anti-Obesity Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009765:Obesity / Q000188:drug therapy* / Q000191:economics*; D010880:Piperidines / Q000191:economics* / Q000627:therapeutic use*; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D000077285:Rimonabant; D016896:Treatment Outcome
D019440:Anti-Obesity Agents; D010880:Piperidines; D011720:Pyrazoles; D000077285:Rimonabant