Key findings
obesity, diabetes
OBESITY, TYPE 2 DIABETES, SENSITIVITY, DIABETES
Our analysis suggests that, from the perspective of a UK healthcare payer, ESG is highly cost effective compared with LM alone for treating adults with class II obesity. The base-case ICER was £2453/QALY gained, falling well below the lower bound of NICE’s typical willingness-to-pay threshold range (£20,000/QALY). Sensitivity and scenario analyses were broadly insensitive to changes in model inputs and assumptions, consistently demonstrating the cost effectiveness of ESG versus LM alone with no ICER estimate exceeding £10,000/QALY. The use of RCT evidence to inform key model inputs represents a strength of our analysis, and the consistency of results across the wide range of sensitivity and scenario analyses we conducted suggests that our overall finding that ESG is cost effective compared with LM alone is robust.The utility estimates for the obesity I and obesity II health states and estimated prevalence of type 2 diabetes in these health states had the largest impact on the ICER in OWSA. The finding that these model inputs had among the largest impacts on the ICER is unsurprising as patients were projected to spend most of the model time horizon in these health states (ESG, obesity I; LM, obesity II) and type 2 diabetes was associated with the highest management costs of the comorbidities included in our model. The MERIT RCT demonstrated that ESG resulted in improvement in diabetes in 93% of patients with diabetes at baseline compared with 15% of patients randomised to LM alone [The MERIT RCT was conducted in the US where LM was based on the Mayo Clinic HEALTH Programme including a low-calorie diet plan and physical activity counselling customised for each individual [Per the NICE reference case [