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Cited by 42Pharmacology and Obesity TreatmentHealth Systems, Economic Evaluations, Quality of LifeObesity, Physical Activity, Diet

Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents

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Lim, Francesca, Bellows, Brandon K., Tan, Sarah Xinhui, Aziz, Zainab, Woo Baidal, Jennifer A., Kelly, Aaron S., Hur, Chin·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2023.29178PMC PMC10472196
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Abstract

Importance: Antiobesity pharmacotherapy is recommended for adolescents ages 12 years and older with obesity. Several medications have been approved by the US Food and Drug Administration for adolescent use, but the most cost-effective medication remains unclear. Objective: To estimate the cost-effectiveness of lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate (7.5 mg phentermine and 46 mg topiramate), top-dose phentermine and topiramate (15 mg phentermine and 92 mg topiramate), or semaglutide among adolescent patients with obesity. Design, Setting, and Participants: This economic evaluation used a microsimulation model to project health and cost outcomes of lifestyle counseling alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide over 13 months, 2 years, and 5 years among a hypothetical cohort of 100 000 adolescents with obesity, defined as an initial body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 37. Model inputs were derived from clinical trials, published literature, and national sources. Data were analyzed from April 2022 to July 2023. Exposures: Lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide. Main Outcomes and Measures: The main outcome was quality-adjusted life years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted 3.0% annually. A strategy was considered cost-effective if the ICER was less than $100 000 per QALY gained. The preferred strategy was determined as the strategy with the greatest increase in QALYs while being cost-effective. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Results: The model simulated 100 000 adolescents at age 15 with an initial BMI of 37, of whom 58 000 (58%) were female. At 13 months and 2 years, lifestyle counseling was estimated to be the preferred strategy. At 5 years, top-dose phentermine and topiramate was projected to be the preferred strategy with an ICER of $56 876 per QALY gained vs lifestyle counseling. Semaglutide was projected to yield the most QALYs, but with an unfavorable ICER of $1.1 million per QALY gained compared with top-dose phentermine and topiramate. Model results were most sensitive to utility of weight reduction and weight loss of lifestyle counseling and top-dose phentermine and topiramate. Conclusions and Relevance: In this economic evaluation of pharmacotherapy for adolescents with obesity, top-dose phentermine and topiramate as adjunct to lifestyle counseling was estimated to be cost-effective after 5 years. Long-term clinical trials in adolescents are needed to fully evaluate the outcomes of pharmacotherapy, especially into adulthood.

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  • For adolescents with severe obesity and comorbidities, pharmacological treatment with phentermine/topiramate ER is cost-effective.

    “Adolescents with severe obesity (≥ 120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy and for them the pharmacological treatment in particular with Phentermine/Topiramate ER is cost effective [110, 111].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [110]

    The Methods (Model Overview; page not provided) describe a simulated cohort whose average participant had severe obesity. The Discussion reports that top-dose phentermine/topiramate, added to lifestyle counseling, was projected to be cost-effective after five years, but not at 13 months or two years. The paper does not establish cost-effectiveness specifically for adolescents with prediabetes, PCOS, MAFLD, or other comorbidities. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Adolescents with severe obesity (≥120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy.

    “Adolescents with severe obesity (≥ 120% of the 95th percentile) and comorbidities such as prediabetes, PCOS, or MAFLD may benefit from pharmacotherapy and for them the pharmacological treatment in particular with Phentermine/Topiramate ER is cost effective [110, 111].”

    From Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan (2025) · cites this paper as [110]

    The Introduction recommends antiobesity medications as an adjunct to lifestyle counseling for adolescents aged 12 or older with obesity, and Methods > Model Overview says the modeled cohort had severe obesity on average (pages not provided). The paper does not identify adolescents with prediabetes, PCOS, or MAFLD as a subgroup that particularly benefits; its cost-effectiveness conclusion applies to top-dose phentermine/topiramate after five years, not specifically to adolescents with those comorbidities. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Lim, F., Bellows, B. K., Tan, S. X., Aziz, Z., Woo Baidal, J. A., Kelly, A. S., & Hur, C.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
  • University of Minnesota (US)
Corresponding author
Hur, Chin
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-08-31
Volume
6
Issue
8
Pages
e2329178
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2023.29178
PMC
PMC10472196
OpenAlex
W4386305208
Cited by
42
References
14
Citations by year
2026: 13 · 2025: 16 · 2024: 11 · 2023: 2
FWCI
6.54
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL146782)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115682)
Topics
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
adolescent obesity, cost-effectiveness, lifestyle counseling, liraglutide, semaglutide, quality-adjusted life years, incremental cost-effectiveness ratio, microsimulation model, body mass index, sensitivity analysis, probabilistic sensitivity analysis
MeSH terms
Liraglutide, Topiramate, Adolescent, Cost-Benefit Analysis, Female, Humans, Male, Phentermine, United States, Pediatric Obesity

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