OBJECTIVES:

Obesity is one of the most prevalent chronic conditions in the United States. The availability of medications, including semaglutide, liraglutide, phentermine/topiramate, and bupropion/naltrexone, provide more options for chronic obesity management. We assessed and compared the cost-effectiveness of these medications for long-term obesity management.

METHODS:

The four medications, along with standard lifestyle modification (LSM), were compared to LSM alone. We developed a decision model followed by Markov model to project lifetime healthcare cost, in 2022 US dollars, and quality adjusted life years (QALYs) from the healthcare sector perspective. The modeled population included adult patients with an average BMI of 38 kg/m² and average age of 45 years. Patients initially without diabetes could transition to states with diabetes, myocardial infarction (MI), stroke, other cardiovascular comorbidity (i.e., angina, transient ischemic attack, or peripheral vascular disease), and heart failure. Weight-lowering effects were identified from a review and network meta-analysis of clinical trial results. All other model inputs were sourced from peer-reviewed literature and publicly available data. We conducted sensitivity analyses to evaluate model uncertainty.

RESULTS:

Respective lifetime cost and QALY estimates were $392K/17.83 for semaglutide, $377K/17.34 for liraglutide, $183K/ 17.38 for phentermine/topiramate, $207K/17.16 bupropion/naltrexone, all added to LSM, and $237K/16.93 for LSM alone. The incremental cost-effectiveness ratios (ICERs) for semaglutide, liraglutide, phentermine/topiramate, and bupropion/naltrexone compared to LSM were $238K, $483K, $8K and $123K per QALY gained, respectively. The model was sensitive to utility gained per unit reduction in BMI, effectiveness of each drug in achieving weight loss, baseline HbA1C, and cost of diabetes care. Estimated life expectancy and cumulative incidence of cardiovascular conditions were comparable to real-world data.

CONCLUSIONS:

Long-term medication therapy to manage obesity may provide individuals with opportunities for sustained weight loss; however, semaglutide and liraglutide would generally require discounted prices to become a cost-effective life-long obesity management strategy.