USING LORCASERIN FOR WEIGHT MANAGEMENT PRIOR TO BARIATRIC SURGERY: MODELING THE COST IMPLICATIONS FOR CALIFORNIA STATE MEDICAID

OBJECTIVES: Many commercial health care plans and state Medicaid programs commonly provide coverage for bariatric surgery for patients with BMI >40 or BMI 35-39.9 with >1 obesity-related comorbidity. Coverage for anti-obesity medications, on the other hand, is less common, though some patients may benefit from anti-obesity medications and avoid bariatric surgery. This study modeled the pharmacy and medical cost implications of treating patients with lorcaserin, an FDA-approved anti-obesity medication, prior to bariatric surgery, in the California Medicaid (MediCal) population. METHODS: The model assumed that severely obese patients (BMI >40) whose weight was reduced to 5% weight loss from baseline at week 12), expected weight loss, and medication acquisition costs ($145/month). The model generated cost estimates over a 2-year timeline from the payer perspective. RESULTS: The number of patients predicted to undergo bariatric surgery was 6,140. Of these, 2,609 (42.5%) would respond to lorcaserin treatment with 459 (17.6%) obtaining a BMI < 35 at one year. Medication costs for those using lorcaserin totaled $6.23 million. Bariatric surgery costs totaled $119.29 million. Predicted cost savings for patients who would avoid bariatric surgery were estimated at $2.82 million. CONCLUSIONS: For MediCal, using lorcaserin to treat obesity prior to bariatric surgery may lead to significant cost saving over a 2-year horizon. Real-world, long-term evidence is needed, however, to further evaluate of the role of lorcaserin for weight management in patients considering bariatric surgery.