John Amos, Vivus CEO

Vivus’ Qsymia beats out weight loss com­peti­tors in pric­ing watch­dog's lat­est cost-ef­fec­tive­ness analy­sis

Cost-ef­fec­tive­ness watch­dog ICER took a look at sev­er­al dif­fer­ent drugs ap­proved for obe­si­ty and weight loss — and to them, there is a clear win­ner.

ICER de­ter­mined that Vivus’ Qsymia, the brand name for the ap­petite sup­pres­sant phen­ter­mine com­bined with the an­ti­con­vul­sant top­i­ra­mate, was more cost ef­fec­tive for weight loss than oth­er com­peti­tors such as No­vo Nordisk’s Sax­en­da and We­govy.

“When treat­ments were com­pared with each oth­er, phen­ter­mine/top­i­ra­mate plus lifestyle mod­i­fi­ca­tion was less cost­ly and more ef­fec­tive than bupro­pi­on/nal­trex­one plus lifestyle mod­i­fi­ca­tion,” the re­view­ers said in their analy­sis.

ICER not­ed in its draft re­port pub­lished Wednes­day, “Med­ica­tions for Obe­si­ty Man­age­ment: Ef­fec­tive­ness and Val­ue,” that med­ical costs re­lat­ed to obe­si­ty can be cost­ly. It’s es­ti­mat­ed that an­nu­al costs as far back as 2016 were around $260 bil­lion.

The new analy­sis from the cost-ef­fec­tive­ness watch­dog group comes more than two weeks af­ter FDA ex­pand­ed Qsymia’s la­bel to now in­clude ado­les­cents ages 12 and up. Grant­ed, the ap­proval was on the con­di­tion that the drug is giv­en on top of both a re­duced-calo­rie di­et and in­creased phys­i­cal ac­tiv­i­ty.

Vivus nabbed ap­proval for Qsymia in adults in 2012, then saw poor sales num­bers. The com­pa­ny end­ed up fil­ing for bank­rupt­cy and be­com­ing a sub­sidiary of Ic­ahn En­ter­pris­es LP.

Out­side Qsymia, the au­thors ex­am­ined three oth­er drugs: Bupro­pi­on and nal­trex­one, a com­bi­na­tion of an an­ti­de­pres­sant drug and an an­ti-ad­dic­tion drug mar­ket­ed by Cur­rax Phar­ma­ceu­ti­cals as Con­trave, and two of No­vo Nordisk’s di­a­betes/weight loss drugs, GLP-1 an­tag­o­nists li­raglu­tide (Sax­en­da) and semaglu­tide (We­govy).

While ICER crowned Qsymia the over­all win­ner, oth­er op­tions may come in handy for dif­fer­ent pa­tients, the re­view­ers said.

“For pa­tients not achiev­ing de­sired weight loss or un­able to tol­er­ate phen­ter­mine/top­i­ra­mate, bupro­pi­on/nal­trex­one may be a cost-ef­fec­tive al­ter­na­tive,” they not­ed, adding that semaglu­tide, while more ef­fec­tive, was more cost­ly and did not meet “com­mon­ly-ac­cept­ed cost-ef­fec­tive­ness thresh­olds.”

“As such, semaglu­tide might be con­sid­ered in pa­tients not achiev­ing de­sired weight loss or un­able to tol­er­ate phen­ter­mine/top­i­ra­mate and bupro­pi­on/nal­trex­one, but on­ly with a sig­nif­i­cant dis­count,” the au­thors said. The whole­sale ac­qui­si­tion cost (WAC) for the drug is more than $17,000 for a year’s sup­ply.

Al­though Qsymia has a WAC of on­ly $2,382 for a year’s sup­ply, the drug can cause fe­tal harm if tak­en while preg­nant, in­clud­ing an in­creased risk of cleft lips and cleft palates. The drug al­so won’t have mar­ket ex­clu­siv­i­ty for too much longer. Gener­ics play­ers Ac­tavis (part of Te­va) and Dr. Red­dy’s reached deals with Vivus in 2017 that will al­low Qsymia gener­ics to en­ter the mar­ket start­ing in De­cem­ber 2024 and in­to 2025.

Bupro­pi­on and nal­trex­one re­port­ed a WAC of $7,393 for a year’s sup­ply, and the oth­er No­vo drug (Sax­en­da) was not too far be­low semaglu­tide’s $17,000-plus year­ly price, clock­ing in at $15,795.

ICER al­so not­ed in its re­port that there were a few lim­i­ta­tions to its analy­sis, in­clud­ing the full im­pact of the drugs in pa­tients with chron­ic kid­ney dis­eases or oth­er con­di­tions where weight loss may be ben­e­fi­cial, such as can­cer.

Illustration: Assistant Editor Kathy Wong for Endpoints News

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