Cost-effectiveness of a low-calorie diet and orlistat for obese persons: modeling long-term health gains through prevention of obesity-related chronic diseases.
OBJECTIVE
Our study estimated the cost-effectiveness of pharmacologic treatment of obesity in combination with a low-calorie diet in The Netherlands.


METHODS
Costs and effects of a low-calorie diet-only intervention and of a low-calorie diet in combination with 1 year of orlistat were compared to no treatment. The RIVM Chronic Disease Model was used to project the differences in quality adjusted life years (QALYs) and lifetime health-care costs because of the effects of the interventions on body mass index (BMI) status. This was done by linking BMI status to the occurrence of obesity-related diseases and by relating quality of life to disease status. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In univariate sensitivity analysis, we assessed how sensitive the results were to several key assumptions.


RESULTS
Incremental costs per QALY gained were Euro 17,900 for the low-calorie diet-only intervention compared to no intervention and Euro 58,800 for the low-calorie diet + orlistat compared to the low-calorie diet only. Assuming a direct relation between BMI and quality of life, these ratios decreased to Euro 6000 per QALY gained and Euro 24,100 per QALY gained. Costs per QALY gained were also sensitive to assumptions about long-term weight loss maintenance.


CONCLUSIONS
Cost-effectiveness ratios of interventions aiming at weight reduction depend strongly on assumptions regarding the relation between BMI and quality of life. We recommend that a low-calorie diet should be the first option for policymakers in combating obesity.
van Baal
Pieter H M
PH
National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, Bilthoven, The Netherlands. pieter.van.baal@rivm.nl
van den Berg
Matthijs
M
Hoogenveen
Rudolf T
RT
Vijgen
Sylvia M C
SM
Engelfriet
Peter M
PM
D000328:Adult; D000368:Aged; D019440:Anti-Obesity Agents / Q000191:economics* / Q000627:therapeutic use; D031204:Caloric Restriction / Q000191:economics*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D006801:Humans; D007783:Lactones / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D018803:Models, Economic; D009765:Obesity / Q000191:economics / Q000628:therapy*; D000077403:Orlistat; D019057:Quality-Adjusted Life Years; D055815:Young Adult
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat