Prospects and Challenges of Adolescent Antiobesity Medication: A Cost-Effectiveness Study

Adolescent obesity has increased for nearly two decades, affecting more than 1 in 5 adolescents, according to a study published in JAMA Network Open. Researchers recommend intensive health behavior and lifestyle interventions as the first-line treatment, but these interventions often yield only modest reductions in BMI, with high attrition rates. In 2023, the American Academy of Pediatrics (AAP) recommended using antiobesity medications (AOMs) as an adjunct to intensive health behavior and lifestyle counseling for adolescents aged 12 years and older.

The study aimed to estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of lifestyle counseling alone and in conjunction with various AOMs (liraglutide, mid-dose phentermine, and topiramate, top-dose phentermine and topiramate, or semaglutide) over a 13-month period and projected the outcomes up to five years. The economic evaluation was based on computer-based modeling, and no human participants were involved.

Clinical trials demonstrated significant reductions in BMI with the use of pharmacologic treatments for adolescent obesity, "with reductions of 4.6% reported for liraglutide, 8.1% reported for mid-dose phentermine and topiramate (ie, 7.5 mg phentermine and 46 mg topiramate daily), 10.4% reported for top-dose phentermine and topiramate (ie, 15 mg phentermine and 92 mg topiramate daily), and 16.7% reported for semaglutide," said researchers.

These medications were approved by the US Food and Drug Administration (FDA) for treating obesity in adolescents aged 12 and older. However, these AOMs are proprietary and come with annual costs ranging from $1100 to $15,000, which raises the question of their cost-effectiveness. The modeling approach simulated a cohort of 100,000 adolescents with baseline characteristics similar to those in clinical trials. Researchers conducted a cost-effectiveness analysis at 13 months, 2 years, and 5 years. The analysis considered various factors, including BMI changes, treatment discontinuation, adverse events, quality-of-life adjustments, and costs.

The study's base case results indicated that lifestyle counseling was the preferred strategy at 13 months. Top-dose phentermine and topiramate became the preferred strategy at 2 years, and by 5 years, it researchers noted it may be the most cost-effective approach. However, semaglutide accumulated the most QALYs but could have been more cost-effective due to its high monthly cost, which would need a significant reduction to become cost-effective.

The findings suggest that adjunctive AOMs, particularly top-dose phentermine and topiramate, may be a cost-effective option for the treatment of adolescent obesity in the long term. Still, the high costs associated with these medications may be a barrier to their widespread use. "While there is evidence that adults discontinue AOMs within 2 years, we modeled a maximum of 5 years of treatment since obesity requires long-term treatment. We may have underestimated the benefit of AOMs, since obesity-related comorbidities may be prevented or delayed in adulthood," said researchers.

The study has limitations, including not including all FDA-approved AOMs for adolescents and the assumption of certain parameters due to the lack of long-term data. "While semaglutide led to the greatest reduction in BMI, it was not cost-effective due to its high cost. Long-term clinical trials are needed to fully understand the safety, efficacy, and cost-effectiveness of AOMs in adolescents," said researchers.

Reference

Lim F, Bellows BK, Tan S, et al. Cost-effectiveness of pharmacotherapy for the treatment of obesity in adolescents. JAMA Network Open. 2023;6(8):e2329178-e2329178. doi:10.1001/jamanetworkopen.2023.29178