EHR data: 1% of eligible patients use weight loss drugs
BOSTON — Prescribing rates for weight-loss drugs to treat obesity remain low, with just 1% of eligible patients using pharmacologic treatment options and “tremendous variability” in provider prescribing rates, according to an analysis of electronic health records presented here.
“Despite directives from authoritative guidelines, rates of prescribing of weight-loss medications to eligible patients appear to be quite low,” Daniel Bessesen, MD, professor of medicine and chief of endocrinology at the University of Colorado and Denver Health Medical Center, said while presenting his study findings. “This is in marked contrast to other chronic metabolic diseases, like diabetes and hypertension, where prescribing rates range from 50% to 80%.”
Bessesen and colleagues analyzed electronic health record data from 2,262,508 adult patients participating in one of eight integrated care systems in the Patient Outcomes Research to Advance Learning (PORTAL) network, part of the Clinical Data Research Network funded by the Affordable Care Act. Participants included five Kaiser Permanente regions, Group Health Cooperative (Washington), HealthPartners (Minnesota and Wisconsin) and Denver Health (Colorado). Available data included patient sex, race or ethnicity, baseline BMI, comorbid conditions, number of prescriptions filled over the observation period, prescribing provider and the medication. The cohort was followed between 2009 and 2013; all participants had at least 12 months of continuous membership without gaps in enrollment between January 2012 and December 2013.
Within the cohort, 23,162 patients (1%) filled a prescription for a weight-loss medication between 2009 and 2013; 85% were women. The mean BMI of patients prescribed a weight-loss drug was 38.9 kg/m²; mean age was 45 years; 44% were white. Researchers found that the generic drug phentermine was the most commonly prescribed (FDA approved for 3 months of use), accounting for 77.3% of all prescriptions. Less commonly prescribed drugs were diethylpropion (16%), phendimetrazine (7.4%) and orlistat (4.5%).
Prescribing rates varied across sites, from a low of 0.55% of eligible patients receiving prescriptions to a high of 2.36%, a greater than four-fold difference across sites. Bessesen noted that 782 (22%) of the providers were “high prescribers,” writing 87% of all prescriptions filled; 32 of those providers were subspecialists and 707 were primary care providers (8% were not defined).
“Low prescribing providers only wrote 1% of the total prescriptions, suggesting that there is great practice variability among physicians,” Bessesen said.
Researchers also found a gradual and steady increase in the number of weight loss prescriptions filled, from 37,277 in 2009 to 48,816 in 2013 (cohort size did not change), suggesting patients were not using the medications continuously, Bessesen said (average of 8.9 fills per patient over 4 years).
Current guidelines endorse the consideration of weight-loss medications for patients with BMI greater than 30 kg/m², or for patients with BMI between 27 and 30 kg/m² and a weight-related comorbidity.
“It’s not clear why this situation exists,” Bessesen said. “Is it a cost issue? Is it fears of providers about the risks of these drugs? Is it patient fears? Is it lack of what is considered to be acceptable levels of efficacy? Or is it provider beliefs about the appropriateness of prescribing weight-loss medications to obese patients? In the future, we hope to address some of these questions.”– by Regina Schaffer
Bessesen D, et al. LB-OR02-5. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2016; Boston.
Disclosure: Bessesen reports serving on the data safety monitoring board for Enteromedics Inc.