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    Diet drugs save money


    Posted by .(JavaScript must be enabled to view this email address)
    Tuesday, March 16, 2004 10:15 pm Email this article
    "We found that treatment with obesity medications reduced overall pharmacy costs with the added benefit of weight loss," concluded a 1999 study.

    “[Diet drugs] reduce pharmacy costs of patients on medications for diabetes, hyperlipidemia or hypertension,” according to a study by Frank Greenway, George Bray and colleagues at the Pennington Biomedical Research Center at Louisiana State University.

    Losing six to ten percent of body weight reduces the cost of drugs and pharmaceutical supplies by an average of $122.64 per month for insulin-treated diabetics, $42.92 per month for sulfonylurea-treated diabetics, $61.07 per month for patients taking cholesterol-lowering drugs, and $0.20 per month for patients taking anti-hypertensive medication.

    These cost savings were calculated based on 1995 wholesale prices.

    SUBJECTS

    The study included 73 people, aged 18- to 60-years-old with a body mass index greater than 30 who were taking medications for diabetes, hyperlipidemia, or hypertension.

    Subjects were given either a combination of ephedrine and caffeine (25 mg of ephedrine—in the form of ephedrine Hcl, I assume, which contains 20 mg of ephedrine—plus 200 mg of caffeine three times per day), mazindol (1 mg per day), Fen-Phen (20 mg of fenfluramine three times per day or 15 mg of dexfenfluramine twice a day plus 15 mg of phentermine once a day) or Fen-Mazindol. (Obviously this study was conducted before fenfluramine and dexfenfluramine were removed from the market.)

    All subjects were instructed on a 1000 calorie per day diet for the first three months as well as attending group sessions where they received advice on exercise, nutrition and behavioral changes.

    WEIGHT LOSS

    After six months weight loss averaged 18.2 percent of body weight for subjects given Fen-Phen or Fen-Mazindol, 16.7 percent for those taking mazindol, 15.5 percent for men and 6.8 percent for women taking ephedrine and caffeine. The authors noted that weight loss with mazindol was greater in this study than has been seen in previous studies (16.7 percent versus 9 percent), while the weight loss with ephedrine-caffeine was less than that seen in other studies (an average of 8.6 percent for both men and women versus 16 percent in other studies). Mazindol is the only weight loss medication approved in Japan, and ephedrine-caffeine is the best-selling diet drug in Denmark the authors noted.

    ABLE TO DECREASE OTHER MEDICINES

    All diabetic subjects who were taking either insulin or sulfonylureas were able to discontinue these medicines.

    This occurred in subjects on insulin after two months of treatment when they had lost 21.8 pounds or 9 percent of body weight.

    This occurred in diabetics on sulfonylureas after six weeks when they had lost 16.7 pounds or 8.2 percent of body weight.

    Two-thirds of subjects taking cholesterol-lowering medicines (64 percent) were able to discontinue their medicines after six weeks when they had lost 18 pounds or 9.7 percent of body weight, while the other one-third (36 percent) continued unchanged.

    Half of patients taking anti-hypertensive medication (56 percent) were able to discontinue their medication after eleven weeks when they had lost 29 pounds or 10.6 percent of body weight, while another one-third (30 percent) were able to reduce the dose and one-sixth (14 percent) continued unchanged.

    DIABETES, HYPERTENSION AND HEART DISEASE

    A body mass index (BMI) of twenty-nine or greater increases the risk of diabetes 27.6 times, the risk of hypertension is 3.9 times, and the risk of cardiovascular disease is 3.5 times compared to a BMI of less than twenty-two the paper notes.

    LDL RISK REDUCTION

    The cardiovascular risk of LDL cholesterol was reduced 1.9 percent by ephedrine-caffeine for every one percent weight loss compared to 1.2 percent by mazindol and 1.3 percent by Fen-Phen/Fen-Mazindol.

    HDL RISK REDUCTION

    The cardiovascular risk of HDL cholesterol was reduced 0.3 percent by ephedrine-caffeine for every one percent weight loss, increased 0.3 percent by mazindol and decreased 0.1 percent by Fen-Phen/Fen-Mazindol.

    SYSTOLIC RISK REDUCTION

    The cardiovascular risk of systolic blood pressure was reduced 1.8 percent by ephedrine-caffeine for every one percent weight loss, 0.7 percent by mazindol and 1.2 percent by Fen-Phen/Fen-Mazindol.

    CARDIOVASCULAR RISK REDUCTION OVER 10 YEARS

    The cardiovascular risk of total cholesterol, HDL cholesterol, and systolic blood pressure over a ten-year period was reduced 13.1 percent by ephedrine-caffeine for every one percent weight loss, by 8.7 percent by mazindol and by 16.3 percent by Fen-Phen/Fen-Mazindol.

    Cardiovascular risk reduction was calculated based on the following assumptions as shown in previous studies: that a decrease in total cholesterol of 1 percent reduces cardiovascular risk by 2 percent; that an increase in HDL cholesterol of 1 percent reduces the risk by 1 percent; and a decrease in systolic blood pressure of 1 mm Hg reduces the risk by 2.73 percent.

    The average monthly cost to reduce cardiovascular risk by one percent would be $0.65 for ephedrine-caffeine, $4.31 for mazindol, and $2.45 for Fen-Phen/Fen-Mazindol.

    EPHEDRINE/CAFFINE MOST COST EFFECTIVE

    The paper concluded that the combination of ephedrine and caffeine was most cost-effective of the three treatments in reducing weight, cardiac risk, and LDL cholesterol.

    Although LDL was reduced with all treatments, the reduction was smaller than with most cholesterol lowering drugs (see table).

    CONCLUSION

    We found that treatment with obesity medications reduced overall pharmacy costs with the added benefit of weight loss, the paper concludes.

    COMMENTS

    This is a great paper. I would like to see this kind of cost analysis for all types of drugs used to treat all types of conditions.

    REFERENCE

    Greenway FL; Ryan DH; Bray GA; Rood JC; Tucker EW; Smith SR. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res 1999 Nov;7(6):523-31.

    Articles on the same subject can be found here:


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