Affording the New Obesity Drugs? We Can't Afford Not to

SAN DIEGO — Although the glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide and semaglutide, have been revolutionary advances for the treatment of obesity, the cost-effectiveness of these agents for treating both obesity and type 2 diabetes remains uncertain based on published analyses.

But potential future changes in the cost-effectiveness dynamics of GLP-1 agonists could tip the balance in their favor. These include lower drug prices and a more nuanced and inclusive assessment of cost-effectiveness that considers broader consequences of treatment with GLP-1 agonists that are not traditionally included in such analyses.

Costs to people with obesity that are generally not part of cost-effectiveness calculations include pain, disability, depression, and bias that affect employment, Carol H. Wysham, MD, said at the recent American Diabetes Association 83rd Scientific Sessions.

Other costs to society left out of conventional calculations are items such as the incremental cost for fuel to transport a heavier population and the carbon-footprint costs for the production and transportation of the excess food produced to feed an over-fed population, added Wysham, an endocrinologist with MultiCare and the Rockwood Clinic in Spokane, Washington.

Analyses Should Include "Things We Don't Often Think About"

"The impact of living with obesity is much greater than what we traditionally calculate in health economics," commented Naveed Sattar, PhD, speaking from the floor during the session.

"Patient happiness and self-esteem are hard to measure and capture as cost impacts. We need to also add carbon dioxide effects and transportation costs, and governments are starting to get wise to this. How to run proper health economics analyses is the key question; we need to do better than what we currently do," said Sattar, a professor of metabolic medicine at the University of Glasgow, UK.

Sattar is lead author of a recent analysis that highlights the overwhelming importance of improved weight management in adults as they age to reduce their risk of developing a broad range of chronic disorders.

"Most chronic conditions are, to differing extents, caused or exacerbated by excess adiposity," was a conclusion of his report.

"It's important to include the costs to society, including things we don't often think about. No one has ever done a cost analysis that includes all the factors" cited by Wysham, said Irl B. Hirsch, MD, another speaker at the session. "No one includes obstructive sleep apnea, degenerative arthritis, and the downstream effects of a high body mass index."

The GLP-1 agonists "are great" for both weight loss and glycemic control, said Hirsch, an endocrinologist and professor at the University of Washington in Seattle. "We can't afford not to use them. These agents have been transformational."

US Has the Highest Drug Costs

Another key factor driving cost-effectiveness is, of course, the relatively high cost of the agents in the class, especially in the United States. Hirsch cited a recently published report in Obesity that quoted monthly US costs of $804 for weekly 2.4-mg injections of semaglutide (Wegovy) and $1418 for daily 3.0-mg injections of liraglutide (Saxenda). Highlighting the relatively high cost of medications in the United States, the report cited a monthly price tag of $95 for the same semaglutide regimen in Turkey and a monthly cost of $252 for the same liraglutide regimen in Norway.

US prices for agents in this class may start to deflate as soon as 2024, when one or more generic versions of liraglutide are expected, following expiration of the US patent later in 2023, Wysham said.

Another pending trigger for lower costs may be the possible decision by the World Health Organization (WHO) to designate liraglutide an "essential medicine" later in 2023, she noted. The WHO received an application for this designation from four US clinicians and is considering it as part of its planned 2023 update to the WHO's Essential Medicines List. Wysham predicts that this designation would "press international pharmaceutical companies to produce [liraglutide] at a much lower cost."

"I'm not saying that drug companies should not profit, but they should not do it on the backs of patients," Wysham declared. "What do we measure by 'cost-effectiveness'? There are so many complications of obesity. For patients with diabetes and obesity we need to look for a little different economic policy."

Wysham has reported being an advisor to Abbott and CeQur and receiving research funding from Eli Lilly and Novo Nordisk. Hirsch has reported being a consultant for Abbott, Embecta, and Hagar, and receiving research funding from Dexcom and Insulet. Sattar has reported receiving consulting fees or speaker honoraria from Abbott Laboratories, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, MSD, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi.

Mitchel L. Zoler is a reporter for Medscape and MDedge based in the Philadelphia area. @mitchelzoler

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