GLP-1 Medications for Weight Reduction Haven't Demonstrated Cost-Effectiveness Yet
GLP-1 Medications for Weight Reduction Haven't Demonstrated Cost-Effectiveness Yet
For individuals grappling with excess weight or obesity, GLP-1 agonists, also known as GLP-1s, have gained popularity as a treatment option. When used in compliance with product guidelines, a proper diet, and exercise regimen, GLP-1s can effectively aid in weight reduction. It may seem plausible that GLP-1 use for weight loss would result in fewer overall medical expenses due to obesity-related complications like diabetes and cardiovascular disease, despite the increased drug expenditure. However, current data contradicts this assumption.
Prime Therapeutics recently published a report stating that individuals not diagnosed with diabetes who use GLP-1 therapies for a period of two years experienced no reduction in medical costs. An examination of healthcare insurance records revealed that the treatment did not lower other medical expenses. Interestingly, average healthcare costs climbed by 46% over the two-year span for patients undertaking GLP-1 treatments for weight loss, rising from $12,695 to $18,507.
The Congressional Budget Office also echoes this sentiment, acknowledging that there's no empirical evidence to support a medical cost reduction. Likewise, research based on a vast clinical trial named SELECT demonstrates cardiovascular benefits for a specific subset with pre-existing cardiovascular disease using Wegovy (semaglutide), a GLP-1 weight loss therapeutic. The Food and Drug Administration extended Wegovy's cardiovascular indication in March 2024.
In the trial, Wegovy decreased the relative risk of a composite primary endpoint, which encompassed cardiovascular deaths, non-fatal myocardial infarctions, and non-fatal strokes, by 20%. However, the data did not indicate a statistically significant reduction in cardiovascular-related deaths. Moreover, the absolute risk reduction was minimal, necessitating a substantial "number needed to treat" of 67 to avoid a single cardiovascular event, such as a heart attack.
Analysis by researchers estimated that approximately 4.7 million U.S. adults would be eligible for the SELECT trial. Utilizing a lifetime simulation model, they projected that semaglutide-based products would prevent 538,000 major cardiovascular events at an added cost of $613 billion. Subsequently, the researchers calculated an incremental cost effectiveness ratio for semaglutide, priced at $700 per month per person, of $443,000 per quality-adjusted life year gained. This ratio surpasses the usual threshold of $150,000 in the U.S. for cost-effective healthcare technologies and services.
Generally, up to 20% of specialty drugs can be financially advantageous, enabling payers to save money due to lower downstream costs. Nevertheless, most prescription drugs do not offset medical expenses. These medications typically necessitate additional financial investment for secondary benefits in comparison to standard care, referred to as "value for money." At present, the latest wave of weight loss drugs is not only inefficient but also fails to meet the criterion for being cost-effective, much less cost-saving.
There may be time-frame implications involved. It might be that GLP-1s for weight loss become cost-effective or even cost-saving in long-term studies. However, since there hasn't been a decade-long GLP-1 trial focused on obesity, this remains to be seen.
If long-term studies do determine cost-effectiveness or cost-savings, U.S. insurers would still confront the challenge of member churn. Given the high cost of these medications, it is unlikely that the same insurer will retain the enrolled patient for a decade to reap potential cost savings. A study pointed out that one in five individuals withdraws from a commercial insurer annually. The churn rate is significantly higher in insurance programs like Medicaid.
This churn observation helps explain why coverage restrictions for GLP-1s used for obesity continue to hinder patients seeking therapy access. Numerous insurers and self-funded employers in the United States have either discontinued coverage or imposed harsh restrictions for 2025, reflecting the monetary and operational predicaments posed by high-priced medications.
If Medicare were to cover weight loss drugs (currently, it only provides coverage for Wegovy for a cardiovascular indication), the program would not be immune to cost issues. Therefore, while the Biden administration's proposed reinterpretation of Medicare Part D coverage for weight loss medications could enable approximately 3.4 million Medicare beneficiaries with obesity to access such treatments, it remains uncertain if the subsequent Trump administration will endorse this initiative due to budgetary concerns.
Furthermore, patient adherence poses an additional challenge for insurers. In the Prime Therapeutics study mentioned earlier, only 25% of patients remained on Wegovy or Ozempic two years later. A study published by the Blue Cross Blue Shield Association indicated an even lower adherence rate of 15% during the same period.
GLP-1s aren't devoid of worth. They indeed render significance to a particular group: The scarcely populated crowd of individuals who persist long enough to attain clinically significant weight reduction. However, the buzz surrounding them overshadows the truths that ought to be incorporated in comprehensive evaluation.
- Despite the increased use of GLP-1 therapies like Wegovy for weight loss, a recent report by Prime Therapeutics found no reduction in medical costs for individuals without diabetes over a two-year period.
- The cost of GLP-1 treatments for weight loss can be significant, as shown by the 46% increase in average healthcare costs to $18,507 over two years in the Prime Therapeutics study.
- The Food and Drug Administration has extended Wegovy's cardiovascular indication, but a large clinical trial found minimal cardiovascular benefits and a substantial "number needed to treat" for a single event.
- Despite the potential cardiovascular benefits, a lifetime simulation model estimated that semaglutide-based products would prevent 538,000 major cardiovascular events at an added cost of $613 billion, resulting in an incremental cost effectiveness ratio of $443,000 per quality-adjusted life year gained.
- concerns about the high cost of GLP-1 treatments for weight loss have led numerous insurers to discontinue coverage or impose harsh restrictions, making it challenging for patients to access these therapies, even if they become cost-effective in long-term studies.