OBJECTIVES: Obesity prevalence is increasing worldwide, with over 4 billion people expected to be impacted by 2035. We investigated the hurdles to reimbursement raised by health technology assessment (HTA) agencies when evaluating GLP-1 therapies in weight management.

METHODS: A total of 7 HTAs from England, France, Canada, Australia, and the Netherlands for semaglutide and liraglutide in weight management were evaluated.

RESULTS: Semaglutide is reimbursed in England and France, and liraglutide is reimbursed in England and the Netherlands; however, access is restricted based on age (France), ineligibility for surgery (Netherlands), BMI and presence of weight-related comorbidities (all). Both therapies are indicated as an adjunct to diet and exercise, but inadequate infrastructure to deliver weight management programmes can be a barrier to wider access to GLP-1s in Canada, Australia, and England. Most HTAs noted the exclusion of patients with type 2 diabetes as a weakness in trial design. All countries identified use of surrogate endpoints in place of long-term clinical outcome measures as a significant limitation, yet England and France accepted that short-term weight loss was likely to have clinical benefit. The use of surrogate measures to predict impact on cardiovascular risk was also considered a significant source of uncertainty in the economic modelling approach, particularly in Canada and Australia. Concerns about the impact of GLP-1–associated gastrointestinal adverse events on discontinuation and on patient compliance were raised in Canada, France, and Australia.

CONCLUSIONS: Despite the significant rising public health and economic consequences of obesity, HTA bodies have adopted a cautious approach to reimbursement of GLP-1s. Availability of long-term evidence of the impact of GLP-1s on cardiovascular risk and adverse events may improve access for new treatments. Tirzepatide has recently been recommended with restrictions in England (draft guidance); however, it is clear that the broader economic case for investing in obesity treatment needs to be made.