Cost-Effectiveness Analysis of Qsymia for Weight Loss

Jul 3, 2014PharmacoEconomics

Cost-Effectiveness of Qsymia for Losing Weight

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Abstract

The incremental cost-effectiveness ratio (ICER) for Qsymia is $48,340 per quality-adjusted life year (QALY) gained.

Qsymia combines phentermine and topiramate and is assessed as a treatment for obesity alongside diet and lifestyle advice.
The analysis indicates that 54% of simulations show an ICER below $50,000 per QALY gained based on initial assumptions.
The cost-effectiveness is sensitive to the duration of benefits maintained after stopping the medication.
If benefits last only one year after cessation, the ICER increases to $74,480 per QALY gained.
Future research is needed to explore how long the benefits of Qsymia last after treatment ends.

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BACKGROUND: Phase 3 clinical trial results reveal that Qsymia is a clinically effective long-term treatment for obesity, but whether this treatment is cost-effective compared to a diet and lifestyle intervention has yet to be explored.

OBJECTIVE: To quantify the incremental cost-effectiveness of Qsymia (phentermine and topiramate extended-release) for health-related quality of life improvements.

STUDY DESIGN AND METHODS: Estimates are based on cost and quality of life outcomes from a 56-week, multicenter, placebo-controlled, phase 3 clinical trial undertaken in 93 health centers in the US. Participants were overweight and obese adults (aged 18-70 years) with a body-mass index of 27-45 kg/m(2) and two or more comorbidities (hypertension, dyslipidemia, diabetes or pre-diabetes or abdominal obesity). The intervention was diet and lifestyle advice plus the recommended dose of Qsymia (phentermine 7.5 mg plus topiramate 46.0 mg) vs. control, which included diet and lifestyle advice plus placebo. The study was from the payer perspective. Costs included the prescription cost, medication cost offsets and physician appointment costs. Effectiveness was measured in terms of quality-adjusted life years gained (QALYs). The main outcome measure was incremental cost per QALY gained of the intervention relative to control.

RESULTS: Our base-case model, in which participants take Qsymia for 1 year with benefits linearly decaying over the subsequent 2 years, generates an incremental cost-effectiveness ratio (ICER) of $48,340 per QALY gained. Using the base-case assumptions, probabilistic sensitivity analyses reveal that the ICER is below $50,000 per QALY in 54 % of simulations. However, results are highly dependent on the extent to which benefits are maintained post medication cessation. If benefits persist for only 1 year post cessation, the ICER increases to $74,480.

CONCLUSION: Although base-case results suggest that Qsymia is cost-effective, this result hinges on the time on Qsymia and the extent to which benefits are maintained post medication cessation. This should be an area of future research.

Key numbers

$48,340

Incremental Cost-Effectiveness Ratio

Base-case ICER for Qsymia treatment

54%

Cost-Effectiveness Simulation Rate

Proportion of simulations below $50,000 per QALY

$74,480

Increased ICER with Reduced Benefits

ICER if benefits persist for only one year post-cessation

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Cost-Effectiveness Analysis of Qsymia for Weight Loss

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