Liraglutide for managing overweight and obesity
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1.1 Liraglutide is not recommended, within its marketing authorisation, for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity.
1.2 This recommendation is not intended to affect treatment with liraglutide that was started in the NHS before this guidance was published. Adults having treatment outside this recommendation may continue without changes to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Obesity is very common in England, affecting about 26% of the adult population. Current management for overweight and obesity is lifestyle measures alone, lifestyle measures with orlistat, or bariatric surgery.
Clinical trial evidence shows that liraglutide with lifestyle measures is more effective for weight loss and delaying the development of type 2 diabetes than lifestyle measures alone. But its long-term effectiveness, particularly on the risk of cardiovascular disease, is unknown.
In its submission, the company made a case for liraglutide's cost-effectiveness in people who were considered at high risk of the adverse consequences of obesity, that is, adults with a BMI ≥ 35 kg/m2 with pre-diabetes and a high risk of cardiovascular disease. It did not provide evidence for the whole population covered by the marketing authorisation.
Because of the uncertainty in the clinical evidence, even in this high-risk subgroup, the cost-effectiveness estimate is highly uncertain and potentially much higher than what NICE considers a cost-effective use of NHS resources. Therefore, liraglutide cannot be recommended.