Despite social benefits, popular weight loss lenses are not cost-effective at current prices

According to a comprehensive new study on the JAMA Health forum, the latest weight loss medications offer impressive health benefits, but the price tag makes it economically unrealistic.

Researchers at the University of Chicago found that injectable drugs such as Tirzepatide (Zepbound) and Semaglutide (Wegovy) offer greater health benefits than older body weight drugs, but their current costs will need to drop to 30% to 82% to meet the cost-effectiveness of the standard threshold.

These findings are due to the continued shortage and insurance wars of these highly sought-after drugs that have changed the treatment for obesity since their introduction, but for many patients, this remains financially unavailable.

“This economic assessment found that although Tilzadete and Semaglutide offer considerable long-term health benefits, it is not cost-effective at current net prices,” concluded the researchers led by Dr. Jennifer Hwang. “Efforts to lower the net prices of new anti-obesity drugs are crucial to ensuring equitable access to highly effective anti-obesity drugs.”

The study uses advanced computer modeling to predict the health status and costs of 126 million qualified U.S. adults who have the potential to benefit from weight loss pills. The researchers compared four FDA-approved drugs and only changed lifestyles with lifestyle changes.

Over his lifetime, Tirzepatide (by Eli Lilly) paid Zepbough—will stop the majority of obesity (45,609 per 100,000 people), diabetes (20,854) and cardiovascular disease (10,655). Semaglutide (by Novo Nordisk sold as Wegovy) is second, preventing 32,087 obesity cases, 19,211 diabetes cases and 8,263 cardiovascular disease cases, per 100,000 people per 100,000.

These health achievements translate into significant improvements in long-term and quality of life. Compared to the lifestyle modification alone, Tirzepatide generates an additional 48,649 years for life-time age per 100,000 people, while Semaglutide adds 35,634 lifespan.

question? price.

Despite the greatest health conditions, Tirzepatide and Semaglutide still fail to meet the standard cost-effectiveness threshold used by health economists. To make Tirzepatide’s current estimated net price per year of $6,236, cost-effective, with a universal threshold of $100,000 per year for quality-adjusted lifetime years, it needs to be lowered to $4,334, a 30.5% reduction. The net price of Semaglutide is $8,412, with just $81.9% off per year and only $1,522 per year.

In contrast, the analysis found that despite its more modest health benefits, the older, cheaper weight loss drug Naltrexone-bupropion (Contrave) is actually cost-free, while benzoate benzoate (QSymia) is proven to be cost-effective by traditional standards.

These findings highlight the complex economics of the weight loss pill boom, driven by the significant efficiency of GLP-1 receptor agonists such as Semaglutide and tirzepatide. The drugs were originally developed for diabetes and showed unprecedented weight loss results in clinical trials, ranging from about 15 to 21% of body weight, which is twice as much as previous drugs could achieve.

The results of the study may affect ongoing debates about the coverage of these drugs. Currently, Medicare coverage is prohibited specifically for weight loss medications, and Medicaid coverage varies by state. Private insurers often limit access through prior authorization requirements and high out-of-pocket expenses, and most Americans take these drugs to pay a considerable amount from their pockets.

That may change soon. In January, the Medicare & Medicaid Service Center proposed the first time that Medicare covers obesity with GLP-1 drugs, a move that would expand access but also significantly increase government health care spending.

The study authors point out that future policy solutions are crucial to improving affordability and the use of these drugs. They believe that the Medicare drug pricing negotiation plan under the Inflation Reduction Act may eventually lower prices, and Semaglutide may be elected as negotiation as early as 2027.

Meanwhile, the authors recommend exploring alternative approaches such as using medication for initial weight loss, followed by low-cost maintenance strategies, including lifestyle modification plans, food-based interventions, or low-dose maintenance treatments.

This study has important limitations. The model projects short-term clinical trial results over a lifetime and assumes that patients can maintain changes in medication and lifestyle indefinitely – which may not reflect real-world usage. The study also cannot account for all the diseases associated with obesity, such as sleep apnea and osteoarthritis, which may improve the cost-effectiveness of the medication, if included.

Currently, this study provides the most comprehensive view of the economic value of these revolutionary drugs, suggesting that their health benefits are considerable, but their current prices remain a significant barrier to widespread use.

Since obesity affects more than two-fifths of American adults and drives huge health care costs, finding sustainable ways to deliver these effective treatments to those who need them represents one of the most pressing challenges in health care that may ultimately require policy changes and price concessions from drug manufacturers.