Rimonabant for the treatment of overweight and obese people
Health Technology Assessment
14 and exercise alone for three base-case populations. The incremental cost-effectiveness ratio (ICER) of rimonabant varied from £10,534-£13,236 per quality-adjusted life-year (QALY) versus diet and exercise, to £8977-£12,138 per QALY versus orlistat, to £1463-£3908 per QALY versus sibutramine. In subgroup analysis there was a wider variation in the ICER estimates although none exceeded £20,000 per QALY. The ICER of rimonabant remained under £20,000 per QALY in reanalyses by the manufacturer
... the manufacturer and the ERG, with the results sensitive to the source of health-related quality of life (HRQoL) benefits in the model. Four treatment strategies were modelled in comparisons of rimonabant versus diet and exercise alone and orlistat and sibutramine in which rimonabant was continued only in patients achieving 5% weight loss at 3, 6, 9 or 12 months. In pairwise comparisons rimonabant remained below a threshold of £30,000 per QALY in 70% of the comparisons reported. The results were most sensitive to the decrement applied to depression and the costs of screening for depression. In conclusion, areas of uncertainty remain in relation to the clinical effectiveness and cost-effectiveness of rimonabant, for example lack of evidence on long-term outcomes and the effect of rimonabant on cardiovascular events, developing diabetes and mortality, and lack of data on the HRQoL benefits associated with rimonabant. The lack of response hurdles applied to sibutramine and orlistat means that the comparator strategies were not considered by the ERG to reflect their respective product licenses or current NHS use. The NICE guidance issued as a result of the STA states that rimonabant is recommended as an adjunct to diet and exercise for adults who are obese or overweight and who have had an inadequate response to, are intolerant of or are contraindicated to orlistat and sibutramine.