1.1 Liraglutide is recommended as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults, only if:
they have a body mass index (BMI) of at least 35 kg/m2 (or at least 32.5 kg/m2 for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population) and
they have non-diabetic hyperglycaemia (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre) and
they have a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia and
it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service and
the company provides it according to the commercial arrangement.
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
Management for overweight and obesity in adults includes lifestyle measures alone, lifestyle measures with orlistat, or bariatric (weight loss) surgery.
The company's evidence submission focuses on people with a BMI of at least 35 kg/m2 with non-diabetic hyperglycaemia and a high risk of cardiovascular disease, because this group of people was at high risk of experiencing the adverse consequences of obesity. They were also likely to gain most from liraglutide. The clinical evidence shows that people lose more weight with liraglutide plus lifestyle measures than with lifestyle measures alone. Liraglutide has also been shown to delay the development of type 2 diabetes and cardiovascular disease.
People from some minority ethnic groups are at an equivalent risk of the consequences of obesity at a lower BMI than the white population. NICE's guideline on BMI recommends using lower BMI thresholds for people from south Asian, Chinese, black African and African-Caribbean populations when identifying the risk of developing type 2 diabetes and providing interventions to prevent it. Therefore, a similar adjustment in the BMI threshold is appropriate when considering liraglutide for people from minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population.
For people with a high BMI, non-diabetic hyperglycaemia and a high risk of cardiovascular disease the cost-effectiveness estimates are within what is normally considered a cost-effective use of NHS resources. For these people, liraglutide is recommended.