Semaglutide, tirzepatide not deemed cost-effective obesity therapies despite benefits
Key takeaways:
- Semaglutide and tirzepatide were the least cost-effective of four obesity drugs examined in a microsimulation model.
- A multifaceted approach is needed to reduce financial barriers to obesity medications.
Semaglutide and tirzepatide confer greater improvements in life expectancy than naltrexone/bupropion and phentermine/topiramate, but their estimated net price is too high for them to be cost-effective, researchers reported.
In findings from a microsimulation model published in JAMA Health Forum, semaglutide (Wegovy, Novo Nordisk) had the highest incremental cost-effectiveness ratio (ICER) of four obesity medications assessed in the study, and tirzepatide (Zepbound, Eli Lilly) had the second-highest ICER. The two medications were the only ones deemed not to be cost-effective for patients.
Jennifer H. Hwang, DO, MSc, DABOM, pathways clinical instructor in the section of general internal medicine, department of medicine at the University of Chicago, said the current prices of semaglutide and tirzepatide are a major barrier for many people with obesity.
“While [semaglutide and tirzepatide] offer significant clinical benefits, their high price makes them unaffordable for both patients and the health care system,” Hwang told Healio. “We need strategies to ensure broader, more equitable access so that these medications can be a scalable solution for obesity treatment.”
Hwang and colleagues used the Diabetes, Obesity, Cardiovascular Disease Microsimulation model to estimate the development of obesity-related conditions, quality of life and health costs for adults with overweight plus one weight-related comorbidity or obesity participating in lifestyle intervention or receiving an obesity drug plus lifestyle intervention. Four medications were assessed: semaglutide, tirzepatide, naltrexone/bupropion (Contrave, Currax Pharmaceuticals) and phentermine/topiramate. Patient data were collected from participants in the 2017-2020 National Health and Nutrition Examination Survey cycle. In the simulation, each adult received one of the medications plus lifestyle intervention or lifestyle intervention alone. Net prices for semaglutide and tirzepatide were estimated using SSR Health data. Prices for naltrexone/bupropion and phentermine/topiramate were obtained from federal supply schedule prices. Medical Expenditure Panel Survey data were used to estimate annual health care costs. A drug was considered to be cost-effective if it had an ICER of $100,000 or less compared with lifestyle intervention alone. Total costs were adjusted for 2023 U.S. dollars.
Compared with lifestyle modification, tirzepatide was associated with the largest reduction in obesity, diabetes and CVD cases, whereas naltrexone/bupropion reduced the lowest number of cases among the four assessed drugs. Tirzepatide contributed 48,649 more life-years gained per 100,000 people, and semaglutide generated 35,634 more life-years gained per 100,000 people than lifestyle intervention alone. Phentermine/topiramate added 20,153 life-years gained per 100,000 people and naltrexone/bupropion generated 11,406 more life-years per 100,000 people compared with lifestyle intervention.
Researchers found adults assigned tirzepatide and semaglutide in the microsimulation had the lowest per-person health care expenditures of the four drugs. However, high net prices for the medications led to semaglutide having an ICER of $467,676 per quality-adjusted life-year and tirzepatide having an ICER of $197,023 per QALY compared with lifestyle intervention alone. Phentermine/topiramate had an ICER of $85,229 per QALY, whereas naltrexone/bupropion was considered to be cost-saving compared with lifestyle intervention.
From a threshold analysis, the researchers determined that tirzepatide would need a 30.5% reduction in net price to become cost-effective, and semaglutide would need an 81.9% decrease in net price to meet the cost-effectiveness threshold.
“It was striking to see that semaglutide would need [about] an 82% discount from its current net price to be considered cost-effective at the $100,000 per quality-adjusted life-year threshold,” Hwang said. “However, uncertainties remain regarding the full extent of health benefits, real-world adherence and potential pricing changes. That said, I anticipate some price reductions with increased market competition.”
Hwang said reducing financial barriers to semaglutide and tirzepatide will require efforts from several stakeholders and include public policy changes and reform in commercial insurance coverages. Hwang added that drugs should be prioritized toward patients who would best benefit from obesity pharmacotherapy.
“Alternative strategies, such as lower-dose maintenance programs after achieving maximum weight loss and integrating lifestyle interventions, could also help ensure sustainable, long-term health improvements,” Hwang said.
For more information:
Jennifer H. Hwang, DO, MSc, DABOM, can be reached at jennifer.hwang2@bsd.uchicago.edu.
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