@article {Maetzel:2003:1170-7690:501,
	author = "Maetzel A.",
	author = "Ruof J.",
	author = "Covington M.",
	author = "Wolf A.",
	title = "Economic Evaluation of Orlistat in Overweight and Obese Patients with Type 2 Diabetes Mellitus",
	journal = "PharmacoEconomics",
	volume = "21",
	year = "2003",
	abstract = "<B>Objective:</B> To estimate the economic value of pharmacological treatment of type 2 diabetes mellitus in overweight and obese patients using orlistat in addition to standard diabetes therapy (i.e., a sulphonlyurea, metformin or insulin) and weight management strategies as compared with standard diabetes therapy and weight management strategies alone in a US-based healthcare setting. The perspective of the study was from the viewpoint of a US healthcare provider.<P></P><B>Design and setting:</B> Markov state transition model simulating diabetes-related complications and mortality for a period of 11 years. Patients were modelled to continue orlistat therapy for a 52-week period, assuming a 3-year period of weight regain where after 3 years bodyweight would match that of the placebo group. The impact of orlistat on glycosylated haemoglobin (HbA<SUB>1c</SUB>) values was evaluated directly using data from four randomised, placebo-controlled, 1-year trials of orlistat in overweight or obese adults with type 2 diabetes who also received standard diabetes pharmacotherapy and intensive lifestyle modification. Incidence rates of micro- and macrovascular complications associated with type 2 diabetes and the estimated relative reduction in incidence rates associated with a decrease in mean updated HbA<SUB>1C</SUB> values were derived from the United Kingdom Prospective Diabetes Study (UKPDS) estimates for a reference population of male patients, 52 years of age.<P></P>US cost estimates were derived from published sources and presented in 2001 US dollars. Discounting of 3&#037; was applied. Probabilistic sensitivity analysis was applied to evaluate the robustness of the results of the persistence of the effect of orlistat after treatment.<P></P><B>Main outcome measures:</B> Average costs and event-free life-years gained during the 11-year period expressed as the incremental costs divided by the incremental gain in life expectancy.<P></P><B>Results:</B> Treatment with orlistat, 120mg three times daily, increased event-free life expectancy by 0.13 years over an 11-year period. Average treatment costs were estimated to be $US19 987 in the orlistat group compared with $US18 865 in the group that received diabetes medication and weight management alone. This translated into a cost-effectiveness ratio of $US8327 per event-free life-year gained.<P></P><B>Conclusion:</B> Adding orlistat as a pharmacological treatment to conventional diabetes and weight management approaches seems to be a cost-effective treatment option for overweight and obese patients with type 2 diabetes.",
	pages = "501-512(12)",
	url = "http://www.ingentaconnect.com/content/adis/pec/2003/00000021/00000007/art00005"
}