Purpose: A substantial portion of the economic burden of obesity is the cost of medications to manage obesity-related comorbidities, including hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM). This post hoc analysis evaluated the effects of magnitude of weight loss (WL) on annual antihypertensive, lipid-lowering, and antidiabetic medication costs in obese/overweight subjects.
Methods: The CONQUER trial was a double-blind, Phase 3 study of 2487 obese/overweight subjects (body-mass index [BMI] ≥27 and ≤45 kg/m2) with ≥2 weight-related comorbidities randomly assigned to placebo (n=994), phentermine (PHEN) 7.5mg/topiramate extended-release (TPM ER) 46mg (7.5/46; n=498), or PHEN 15mg/TPM ER 92mg (15/92; n=995) plus lifestyle modifications for 56 weeks. Subjects included in this post hoc analysis completed ≥12 weeks of therapy and received medications at baseline or endpoint for the treatment of ≥1 of the following comorbidities: hypertension (n=830), dyslipidemia (n=340), or T2DM (n=207). Annual antihypertensive, lipid-lowering, and antidiabetic medication costs were calculated at baseline and end of treatment by multiplying the unit cost (Medi-Span's PriceRx database) by number of doses per day and by 365. Subjects were stratified by magnitude of WL (<5%, ≥5%-<10%, ≥10%-<15%, and ≥15%), and changes in annual medication costs were evaluated from baseline to end of treatment.
Results: Most subjects were female (70%) and Caucasian (86%); mean
weight was 103.1±17.9kg and mean BMI was 36.6±4.5kg/m2. At treatment
end, the majority of subjects with <5%
WL were from the placebo group, while the majority of subjects achieving
≥5% WL were from the PHEN/TPM ER groups (Table). Compared with subjects
losing <5% body weight, changes in
annual medication cost for ≥5%-<10%
WL were -$107.27, -$167.86, and -$76.18 for the treatment of hypertension,
dyslipidemia, and T2DM, respectively. Similarly,
changes in annual medication cost in subjects with ≥10%-<15% WL were
-$99.54, -$242.83, and -$271.17, respectively, and for subjects with ≥15%
WL were -$229.26, -$594.48, and -$244.94, respectively. Common treatment-emergent adverse events were
constipation, dry mouth, and paraesthesia.
Conclusions: In this obese/overweight population, increasing magnitudes of WL were associated with greater reductions in annual medication costs for the treatment of hypertension, dyslipidemia, and T2DM. This suggests that ≥5% WL may have a meaningful and beneficial impact on the economic burden of obesity.
Dr. Cheskin is a stockholder and member of the National Advisory Board of VIVUS, Inc.
