{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:15:03Z","timestamp":1792095303727,"version":"4.4.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Although the American Academy of Pediatrics has recommended treatment with antiobesity drugs for adolescents, the cost-effectiveness of antiobesity drugs for this population is still unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To quantify cost-effectiveness of different antiobesity drugs available for pediatric use.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This economic evaluation used a Markov microsimulation model with health states defined by obesity levels. Effectiveness was measured by quality-adjusted life-years (QALYs) and costs were calculated from third-party payer perspective, estimated in 2023 US dollars over a 10-year horizon. Data were obtained from the published literature.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Antiobesity drugs orlistat, liraglutide, semaglutide, and phentermine-topiramate vs no treatment. Metformin hydrochloride and 2 types of bariatric surgical procedures (sleeve gastrectomy and gastric bypass) were considered in sensitivity analysis.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Incremental cost-effectiveness ratio.<\/jats:p><\/jats:sec>Results<\/jats:title>Among the 4 antiobesity drugs currently approved for pediatric use, phentermine-topiramate was the most cost-effective with an incremental cost-effectiveness ratio of $93\u202f620 per QALY relative to no treatment in this simulated cohort of 10\u202f000 adolescents aged 12 to 17 years (mode, 15 years) with severe obesity (62% female). While semaglutide offered more QALYs than phentermine-topiramate, its higher cost resulted in an incremental cost-effectiveness ratio ($1\u202f079\u202f480\/QALY) that exceeded the commonly used willingness-to-pay threshold of $100\u202f000 to $150\u202f000\/QALY. Orlistat and liraglutide cost more and were less effective than phentermine-topiramate and semaglutide, respectively. Sleeve gastrectomy and gastric bypass were more effective than phentermine-topiramate but were also more costly, rendering them not cost-effective compared with phentermine-topiramate at the willingness-to-pay threshold of $100\u202f000 to $150\u202f000\/QALY.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this economic evaluation of weight loss drugs for adolescents with severe obesity, we found phentermine-topiramate to be a cost-effective treatment at a willingness-to-pay threshold of $100\u202f000 to $150\u202f000\/QALY. Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.36400","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T15:01:00Z","timestamp":1697122860000},"page":"e2336400","source":"Crossref","is-referenced-by-count":43,"title":["Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity"],"prefix":"10.1001","volume":"6","author":[{"given":"Shweta","family":"Mital","sequence":"first","affiliation":[{"name":"College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai V.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Memorial University of Newfoundland, St John\u2019s, Newfoundland and Labrador, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"issue":"6","key":"zoi231049r1","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1111\/joim.v292.6","article-title":"Pediatric obesity\u2014long-term consequences and effect of weight loss.","volume":"292","author":"Marcus","year":"2022","journal-title":"J Intern Med"},{"issue":"22","key":"zoi231049r2","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1056\/NEJMoa1703860","article-title":"Simulation of growth trajectories of childhood obesity into adulthood.","volume":"377","author":"Ward","year":"2017","journal-title":"N Engl J Med"},{"issue":"2","key":"zoi231049r4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"issue":"11","key":"zoi231049r6","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1056\/NEJMp2300516","article-title":"Medicare Part D coverage of antiobesity medications\u2014challenges and uncertainty ahead.","volume":"388","author":"Baig","year":"2023","journal-title":"N Engl J Med"},{"issue":"5","key":"zoi231049r12","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1002\/oby.v31.5","article-title":"Estimated minimum prices and lowest available national prices for antiobesity medications: improving affordability and access to treatment.","volume":"31","author":"Levi","year":"2023","journal-title":"Obesity (Silver Spring)"},{"issue":"24","key":"zoi231049r13","doi-asserted-by":"publisher","first-page":"2245","DOI":"10.1056\/NEJMoa2208601","article-title":"Once-weekly semaglutide in adolescents with obesity.","volume":"387","author":"Weghuber","year":"2022","journal-title":"N Engl J Med"},{"issue":"22","key":"zoi231049r14","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1056\/NEJMoa1916038","article-title":"A randomized, controlled trial of liraglutide for adolescents with obesity.","volume":"382","author":"Kelly","year":"2020","journal-title":"N Engl J Med"},{"issue":"23","key":"zoi231049r15","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1001\/jama.293.23.2873","article-title":"Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial.","volume":"293","author":"Chanoine","year":"2005","journal-title":"JAMA"},{"issue":"6","key":"zoi231049r16","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2200014","article-title":"Phentermine\/topiramate for the treatment of adolescent obesity.","volume":"1","author":"Kelly","year":"2022","journal-title":"NEJM Evid"},{"issue":"6","key":"zoi231049r19","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1016\/j.numecd.2023.03.012","article-title":"Cost-effectiveness analysis of five anti-obesity medications from a US payer\u2019s perspective.","volume":"33","author":"G\u00f3mez Lumbreras","year":"2023","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"7","key":"zoi231049r20","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s40273-014-0182-6","article-title":"Cost-effectiveness analysis of Qsymia for weight loss.","volume":"33","author":"Finkelstein","year":"2015","journal-title":"Pharmacoeconomics"},{"issue":"2","key":"zoi231049r21","doi-asserted-by":"publisher","DOI":"10.1111\/cob.2019.9.issue-2","article-title":"Incremental cost-effectiveness of evidence-based non-surgical weight loss strategies.","volume":"9","author":"Finkelstein","year":"2019","journal-title":"Clin Obes"},{"issue":"7","key":"zoi231049r22","doi-asserted-by":"publisher","first-page":"740","DOI":"10.18553\/jmcp.2022.28.7.740","article-title":"Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and obesity in the United States.","volume":"28","author":"Kim","year":"2022","journal-title":"J Manag Care Spec Pharm"},{"issue":"2","key":"zoi231049r23","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1002\/osp4.v6.2","article-title":"The cost-effectiveness of pharmacotherapy and lifestyle intervention in the treatment of obesity.","volume":"6","author":"Lee","year":"2019","journal-title":"Obes Sci Pract"},{"key":"zoi231049r24","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1043650","article-title":"Anti-obesity pharmacotherapy for treatment of pediatric type 2 diabetes: review of the literature and lessons learned from adults.","volume":"13","author":"Bensignor","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"1","key":"zoi231049r25","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jval.2021.10.008","article-title":"Consolidated health economic evaluation reporting standards (CHEERS) 2022 explanation and elaboration: a report of the ISPOR CHEERS II good practices task force.","volume":"25","author":"Husereau","year":"2022","journal-title":"Value Health"},{"issue":"3","key":"zoi231049r26","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials.","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"zoi231049r27","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.annepidem.2021.01.003","article-title":"Life-long body mass index trajectories and mortality in two generations.","volume":"56","author":"Zheng","year":"2021","journal-title":"Ann Epidemiol"},{"issue":"3","key":"zoi231049r29","doi-asserted-by":"publisher","first-page":"512","DOI":"10.2105\/AJPH.2013.301597","article-title":"Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death.","volume":"104","author":"Borrell","year":"2014","journal-title":"Am J Public Health"},{"issue":"3","key":"zoi231049r30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0247307","article-title":"Association of body mass index with health care expenditures in the United States by age and sex.","volume":"16","author":"Ward","year":"2021","journal-title":"PLoS One"},{"issue":"10","key":"zoi231049r31","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine.","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"issue":"8","key":"zoi231049r33","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1007\/s11695-017-3100-0","article-title":"Cost-effectiveness analysis of bariatric surgery for morbid obesity.","volume":"28","author":"Alsumali","year":"2018","journal-title":"Obes Surg"},{"key":"zoi231049r34","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1002\/oby.v31.5","article-title":"Updating cost-effectiveness\u2014the curious resilience of the $50,000-per-QALY threshold.","volume":"371","author":"Neumann","year":"2014","journal-title":"N Engl J Med"},{"issue":"3","key":"zoi231049r35","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-044982","article-title":"Metformin treatment of pediatric obesity.","volume":"147","author":"Raman","year":"2021","journal-title":"Pediatrics"},{"key":"zoi231049r37","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1056\/NEJMoa1506699","article-title":"Weight loss and health status 3 years after bariatric surgery in adolescents.","volume":"374","author":"Inge","year":"2016","journal-title":"N Engl J Med"},{"issue":"22","key":"zoi231049r38","doi-asserted-by":"publisher","first-page":"1909","DOI":"10.1001\/jama.2023.7592","article-title":"Childhood obesity at the crossroads of science and social justice.","volume":"329","author":"Ludwig","year":"2023","journal-title":"JAMA"},{"issue":"5","key":"zoi231049r39","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1002\/oby.v31.5","article-title":"Can we have our cake and eat it too? not when it comes to antiobesity medication prices.","volume":"31","author":"Finkelstein","year":"2023","journal-title":"Obesity (Silver Spring)"},{"key":"zoi231049r3","unstructured":"Reuters. US experts recommend weight-loss drugs for obese children. Published January 9, 2023. Accessed April 8, 2023. https:\/\/www.reuters.com\/world\/us\/us-experts-recommend-weight-loss-drugs-obese-children-2023-01-09\/"},{"key":"zoi231049r5","unstructured":"CBC News. Will Canada follow the US\u2019s aggressive new approach to treat childhood obesity? Published February 14, 2023. Accessed April 8, 2023. https:\/\/www.cbc.ca\/news\/health\/us-canada-obesity-guidelines-1.6746380"},{"key":"zoi231049r7","unstructured":"Global News. Ozempic: the trendy drug Americans are shopping for in Canada amid shortages. Published 2023. Accessed April 29, 2023. https:\/\/globalnews.ca\/news\/9409024\/ozempic-drug-shortage-america-wegovy\/"},{"key":"zoi231049r8","unstructured":"New York Post. Hollywood\u2019s new secret to losing weight is a diabetes injection. Published 2022. Accessed April 29, 2023. https:\/\/nypost.com\/2022\/10\/11\/hollywoods-new-secret-to-losing-weight-is-a-diabetes-injection\/"},{"key":"zoi231049r9","unstructured":"US News. Diabetes med Ozempic in short supply as Americans use it for weight loss. Published 2022. Accessed April 29, 2023. https:\/\/www.usnews.com\/news\/health-news\/articles\/2022-12-21\/diabetes-med-ozempic-in-short-supply-as-americans-use-it-for-weight-loss"},{"key":"zoi231049r10","unstructured":"NPR. Wegovy works. but here\u2019s what happens if you can\u2019t afford to keep taking the drug. Published January 30, 2023. Accessed April 8, 2023. https:\/\/www.npr.org\/sections\/health-shots\/2023\/01\/30\/1152039799\/ozempic-wegovy-weight-loss-drugs"},{"key":"zoi231049r11","unstructured":"Affairs? V. Office of Procurement, Acquisition and Logistics (OPAL): pharmaceutical prices. Published 2023. Accessed April 29, 2023. https:\/\/www.va.gov\/opal\/nac\/fss\/pharmprices.asp"},{"key":"zoi231049r17","unstructured":"Washington Post. Their child\u2019s obesity drug was working. then their plan refused to pay. Published March 26, 2023. Accessed May 11, 2023. https:\/\/www.washingtonpost.com\/health\/2023\/03\/26\/ozempic-insurance-coverage-children\/"},{"key":"zoi231049r18","unstructured":"Institute for Clinical and Economic Review. Medications for obesity management: effectiveness and value. Published 2022. Accessed April 30, 2023. https:\/\/icer.org\/wp-content\/uploads\/2022\/03\/ICER_Obesity_Evidence_Report_083122.pdf"},{"key":"zoi231049r28","unstructured":"US Centers for Disease Control and Prevention. US life tables. Published 2018. Accessed August 11, 2023. https:\/\/www.cdc.gov\/nchs\/products\/life_tables.htm"},{"key":"zoi231049r32","unstructured":"Ward? ZJ, Barrett? JL, Cradock? AL, . Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model technical documentation: details on model parameters. Published 2023. Accessed August 13, 2023. https:\/\/choicesproject.org\/wp-content\/uploads\/2023\/03\/CHOICES-Model-Technical-Documentation-v4.6.1.pdf"},{"key":"zoi231049r36","unstructured":"Medical News Today. Metformin and weight loss: does this drug help? Published 2023. Accessed August 13, 2023. https:\/\/www.medicalnewstoday.com\/articles\/320750"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2810584\/mital_2023_oi_231049_1696428267.74858.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T15:01:06Z","timestamp":1697122866000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2810584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":39,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.36400","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]}}}