This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010–2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort (N = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort (N = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%–10%, 10%–15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.
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References
1.
Centers for Disease Control and Prevention. Adult Obesity Facts. Updated May 17, 2022. https://www.cdc.gov/obesity/data/adult.html#:∼:text=The%20obesity%20prevalence%20was%2039.8,adults%20aged%2060%20and%20older Accessed June29, 2022.
2.
WardZJ, BleichSN, CradockAL, et al.Projected US state-level prevalence of adult obesity and severe obesity. New Engl J Med, 2019; 381:2440–2450.
3.
RamasamyA, LalibertéF, AktavoukianSA, et al.Direct and indirect cost of obesity among the privately insured in the United States: a focus on the impact by type of industry. J Occup Environ Med, 2019; 61:877–886.
4.
CawleyJ, BienerA, MeyerhoeferC, et al.Direct medical costs of obesity in the United States and the most populous states. JMCP, 2021; 27:354–366.
5.
The Management of Adult Overweight and Obesity Work Group. Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Overweight and Obesity. v3.0 July 2020. https://www.healthquality.va.gov/guidelines/CD/obesity/VADoDObesityCPGFinal5087242020.pdf Accessed June28, 2022.
6.
JensenMD, RyanDH, ApovianCM, et al.2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol, 2014; 63(25 Part B):2985–3023.
7.
GarveyWT, MechanickJI, BrettEM, et al.American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract, 2016; 22:1–203.
8.
BrelandJY, PhibbsCS, HoggattKJ, et al.The obesity epidemic in the Veterans Health Administration: prevalence among key populations of women and men veterans. J Gen Intern Med, 2017; 32:11–17.
9.
Department of Veterans Affairs. MOVE! Weight Management Program. https://www.move.va.gov/MOVE/QandA.asp Accessed November2, 2021.
10.
KinsingerLS, JonesKR, KahwatiL, et al.Design and dissemination of the MOVE! Weight-Management Program for Veterans. Prev Chronic Dis, 2009; 6:A98.
11.
BatchBC, GoldsteinK, Yancy JrWS, et al.Outcome by gender in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere weight management program. J Womens Health, 2018; 27:32–39.
12.
KahwatiLC, LanceTX, JonesKR, KinsingerLS. RE-AIM evaluation of the Veterans Health Administration's MOVE! weight management program. Transl Behav Med, 2011; 1:551–560.
13.
ChanSH, RaffaSD. Examining the dose–response relationship in the Veterans Health Administration's MOVE!® Weight Management Program: a nationwide observational study. J Gen Intern Med, 2017; 32:18–23.
14.
MaciejewskiML, Shepherd-BaniganM, RaffaSD, WeidenbacherHJ. Systematic review of behavioral weight management program MOVE! for veterans. Am J Prev Med, 2018; 54:704–714.
15.
BoothHP, PrevostTA, WrightAJ, GullifordMC. Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis. Fam Pract, 2014; 31:643–653.
16.
FunkMD, LeeM, VidoniML, ReiningerBM. Weight loss and weight gain among participants in a community-based weight loss challenge. BMC Obes, 2019; 6:1–9.
17.
GreenwayF. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes, 2015; 39:1188–1196.
18.
National Institute of Diabetes and Digestive and Kidney Diseases. Prescription Medications to Treat Overweight & Obesity. June 2021. https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity Accessed June30, 2022.
CalderonG, Gonzalez-IzundeguiD, ShanKL, et al.Effectiveness of anti-obesity medications approved for long-term use in a multidisciplinary weight management program: a multi-center clinical experience. Int J Obes, 2022; 46:555–563.
25.
SalariN, JafariS, DarvishiN, et al.The best drug supplement for obesity treatment: a systematic review and network meta-analysis. Diabetol Metab Syndr, 2021; 13:1–12.
26.
AhmadNN, RobinsonS, Kennedy-MartinT, PoonJL, KanH. Clinical outcomes associated with anti-obesity medications in real-world practice: a systematic literature review. Obes Rev, 2021; 22:e13326.
27.
ZhangL, LiuZ, LiaoS, HeH, ZhangM. Cardiovascular safety of long-term anti-obesity drugs in subjects with overweight or obesity: a systematic review and meta-analysis. Eur J Clin Pharmacol, 2021; 77:1611–1621.
28.
LeBlancES, PatnodeCD, WebberEM, RedmondN, RushkinM, O'ConnorEA. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 2018; 320:1172–1191.
29.
PantaloneKM, SmolarzBG, RamasamyA, et al.Effectiveness of combining antiobesity medication with an employer-based weight management program for treatment of obesity: a randomized clinical trial. JAMA Netw Open, 2021; 4:e2116595.
30.
ShibuyaK, AliKF, JiX, et al.The benefit of short-term weight loss with anti-obesity medications in real-world clinical practice. Endocr Pract, 2019; 25:1022–1028.
31.
TrensonL, TrensonS, van NesF, et al.Liraglutide for weight management in the real world: significant weight loss even if the maximal daily dose is not achieved. Obes Facts, 2022; 15:83–89.
32.
WhartonS, LiuA, PaksereshtA, et al.Real-world clinical effectiveness of liraglutide 3.0 mg for weight management in Canada. Obesity, 2019; 27:917–924.
33.
Del ReA, FrayneSM, HarrisAH. Antiobesity medication use across the veterans health administration: patient-level predictors of receipt. Obesity, 2014; 22:1968–1972.
34.
PendseJ, Vallejo-GarcíaF, ParzialeA, CallananM, TennerC, AlemánJO. Obesity pharmacotherapy is effective in the veterans affairs patient population: a local and virtual cohort study. Obesity, 2021; 29:308–316.
35.
GrabarczykTR. Observational comparative effectiveness of pharmaceutical treatments for obesity within the Veterans Health Administration. Pharmacotherapy, 2018; 38:19–28.
36.
Department of Veterans Affairs. Corporate Data Warehouse (CDW). https://www.hsrd.research.va.gov/for_researchers/vinci/cdw.cfm Accessed December16, 2021.
37.
Department of Veterans Affairs. Cost of VA Staff & Labor. https://www.herc.research.va.gov/include/page.asp?id=cost-stf-labor Accessed December16, 2021.
38.
Food and DrugAdministration. FDA Approves New Drug Treatment for Chronic WeightManagement, FirstSince . June 4, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 Accessed June30, 2022.
39.
QuanH, ParsonsGA, GhaliWA. Validity of information on comorbidity derived from ICD-9-CCM administrative data. Med Care, 2002:675–685.
40.
LundgrenJR, JanusC, JensenSB, et al.Healthy weight loss maintenance with exercise, liraglutide, or both combined. New Engl J Med, 2021; 384:1719–1730.
41.
WaddenTA, WalshOA, BerkowitzRI, et al.Intensive behavioral therapy for obesity combined with liraglutide 3.0 mg: a randomized controlled trial. Obesity, 2019; 27:75–86.
42.
WaddenTA, TronieriJS, SugimotoD, et al.Liraglutide 3.0 mg and intensive behavioral therapy (IBT) for obesity in primary care: The SCALE IBT randomized controlled trial. Obesity, 2020; 28:529–536.
43.
HussainA, AliI, IjazM, RahimA. Correlation between hemoglobin A1c and serum lipid profile in Afghani patients with type 2 diabetes: hemoglobin A1c prognosticates dyslipidemia. Ther Adv Endocrinol Metab, 2017; 8:51–57.
44.
PelhamJH, HanksL, AslibekyanS, DowlaS, AshrafAP. Higher hemoglobin A1C and atherogenic lipoprotein profiles in children and adolescents with type 2 diabetes mellitus. J Clin Transl Endocrinol, 2019; 15:30–34.
45.
RezaeiM, RabizadehS, MirahmadM, et al.The association between advanced glycation end products (AGEs) and ABC (hemoglobin A1C, blood pressure, and low-density lipoprotein cholesterol) control parameters among patients with type 2 diabetes mellitus. Diabetol Metab Syndr, 2022; 14:1–10.
46.
DavisPJ, LiuM, ShermanS, et al.HbA1c, lipid profiles and risk of incident type 2 diabetes in United States Veterans. PLoS One, 2018; 13:e0203484.
47.
LyuB, ChangAR, InkerLA, SelvinE, GramsME, ShinJ-I. Socioeconomic status and use of obesogenic and anti-obesity medications in the United States: a population-based study. Lancet Reg Health Am, 2022; 11:100249.
48.
MacEwanJ, KanH, ChiuK, PoonJL, ShindeS, AhmadNN. Antiobesity medication use among overweight and obese adults in the United States: 2015–2018. Endocr Pract, 2021; 27:1139–1148.
49.
SemlaTP, RuserC, GoodCB, et al.Pharmacotherapy for weight management in the VHA. J Gen Intern Med, 2017; 32:70–73.
TakYJ, LeeSY. Long-term efficacy and safety of anti-obesity treatment: where do we stand?. Curr Obes Rep, 2021; 10:14–30.
52.
YanovskiSZ, YanovskiJA. Progress in pharmacotherapy for obesity. JAMA, 2021; 326:129–130.
53.
GranaraB, LaurentJ. Provider attitudes and practice patterns of obesity management with pharmacotherapy. J Am Acad Nurse Pract, 2017; 29:543–550.
54.
SafaviR, LihA, KirkpatrickS, HallerS, BailonyM. Impact of anti-obesity medication initiation and duration on weight loss in a comprehensive weight loss programme. Obes Sci Pract, 2019; 5:468–478.
55.
KraschnewskiJ, BoanJ, EspositoJ, et al.Long-term weight loss maintenance in the United States. Int J Obes, 2010; 34:1644–1654.
56.
GomezG, StanfordFC. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Int J Obes, 2018; 42:495–500.
57.
ChenF, SuW, RamasamyA, et al.Ten-year Medicare budget impact of increased coverage for anti-obesity intervention. J Med Econ, 2019; 22:1096–1104.
58.
KabiriM, Sexton WardA, RamasamyA, et al.Simulating the fiscal impact of anti-obesity medications as an obesity reduction strategy. Inquiry, 2021; 58:0046958021990516.
59.
GoodrichDE, LoweryJC, BurnsJA, RichardsonCR. The phased implementation of a national telehealth weight management program for veterans: mixed-methods program evaluation. JMIR Diabetes, 2018; 3:e9867.
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