The anti-obesity drug orlistat (Xenical) should be available throughout England and Wales on the NHS, the government's drug advisory body has recommended. The decision by the National Institute for Clinical Excellence (NICE) should put an end to “postcode prescribing,” which has led to a 16-fold difference between the areas where it is most commonly prescribed and the areas where it is least prescribed.
The institute sets outs strict guidelines for prescribing orlistat as one part of the management of obesity. It should be prescribed only to adults (aged 18 to 75 years) who either have a body mass index of “28 (weight(kg)/ (height(m)2)) and also have a serious illness (such as type 2 diabetes or hypertension) or have a body mass index of “30 but have no associated illnesses. Before the drug is prescribed, a patient should have already lost at least 2.5 kg by dieting and increasing physical activity.
To continue taking the drug, patients must also fulfil strict criteria. Treatment should continue for more than three months only if the patient has lost at least 5% of his or her body weight from the start of drug treatment; it should continue for more than six months only if weight loss has been at least 10% of body weight.
Professor Peter Littlejohns, the institute's clinical director, said: “It is not simply a matter of taking a pill. Patients have to undergo a general programme of change in lifestyle and diet. Those with severe weight problems who demonstrate commitment to weight loss will benefit.”
The recommendation will have a significant impact on the NHS drug budget. The cost of treatment per patient is estimated to be £537 ($806) a year. The institute estimates that if the guidance is implemented it will cost around £12m in the first year—double the current drug costs. This estimate is based on an extra 11000 people being prescribed orlistat.
But Professor Littlejohns said: “This is a cost effective drug both in terms of the health of the individual and in terms of preventing long term diseases, including type 2 diabetes and hypertension.”
Trials have shown that mean weight loss per year achieved with orlistat is 2-5 kg greater than that achieved with placebo. This has been accompanied by small but significant reductions in total cholesterol levels, the ratio of total cholesterol level to high density lipoprotein level and diastolic and systolic blood pressure. There is no evidence of the drug's efficacy in reducing a person's weight for periods over 12 months, and the drug is licensed for use only up to 24 months.
The full guidance and supporting documentation can be found at www.nice.org.uk
Figure.
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Patients will have to lose 2.5 kg before being prescribed orlistat