Weight loss surgery more ‘cost saving’ over long term vs. semaglutide for class II obesity
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Key takeaways:
- Compared with semaglutide, endoscopic sleeve gastroplasty reduced total cost by $33,583 over 5 years.
- The annual cost of semaglutide would need to be reduced from $13,618 to $3,591 to be cost-competitive.
Endoscopic sleeve gastroplasty was more cost-effective and sustained greater weight loss over 5 years compared with semaglutide for patients with class II obesity, according to data published in JAMA Network Open.
“Endoscopic sleeve gastroplasty (ESG) is the most effective endoscopic bariatric and metabolic therapy that is attracting attention worldwide,” Muhammad Haseeb, MD, MSc, of the division of gastroenterology, hepatology and endoscopy at Brigham and Women’s Hospital, and colleagues wrote. “In addition, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide and liraglutide), have recently attracted increased attention.”
They continued: “Although glucagon-like peptide-1 receptor agonists and ESG are seeing markedly increased use, their comparative cost-effectiveness is unknown.”
In an economic evaluation study using a Markov cohort model, researchers compared the cost-effectiveness of ESG and semaglutide over 5 years, with a no-treatment baseline strategy, among patients with class II obesity (BMI, 35-39.9). First-year data included in the model were derived from the STEP 1 and MERIT randomized clinical trials, while data from years 2 to 5 were derived from published studies and publicly available data sources. The base case was a 45-year-old patient with class II obesity and a BMI of 37.
Outcomes of interest included quality-adjusted life-years (QALYs), total costs (adjusted to 2022 U.S. dollars) and incremental cost-effectiveness ratios (ICERs). Researchers used a willingness-to-pay threshold of $100,000 per QALY to evaluate cost-effectiveness.
According to the base-case analysis, the QALYs accumulated over 5 years were 3.55 for no treatment, 3.6 for semaglutide and 3.66 for ESG. The semaglutide strategy cost $33,583 more than ESG during this time, and approximately 20% of modeled patients discontinued use due to medication intolerance, among other reasons.
Although ESG was not cost-effective vs. semaglutide over 1 year, it became cost saving at 2 years and continued over a 5-year time horizon, with an ICER of –$595,532 per QALY. Further analysis showed ESG achieved and sustained greater weight loss compared with semaglutide (BMI 31.7 vs. 33).
The researchers noted the annual cost of semaglutide would need to “decrease by more than 3-fold” — from $13,618 to $3,591 — to be a cost-competitive alternative.
“This economic evaluation study suggests that ESG is cost saving compared with semaglutide for class II obesity,” Haseeb and colleagues wrote. “This finding is due to the increased effectiveness and lower costs of ESG and the increased dropout rates over time with semaglutide.”
They added, “The strategic choice of cost-saving yet effective treatment such as ESG compared with semaglutide for specific patient groups could help alleviate the potential budget strain expected from the use of semaglutide.”
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