More and more evidence shows that GLP-1 medications are good for losing weight and reducing the amount of metabolic disease in people with obesity. But only about 52% of employers currently cover these drugs for obesity, and these employers are facing rising costs.
Previous research has shown that the cost of these drugs will exceed any medical cost savings, as is true for most medical interventions. For example, medical plans don’t save money by treating cancer or providing dialysis for patients with kidney failure.
JAMA Network Open recently published a study that showed that healthcare spending could decrease based on the type of weight loss seen with use of GLP-1 medications. However, the study demonstrates once again that even with their impressive impacts on patient weight and health, an employer-sponsored health insurance plan should not expect net medical savings from these medications.
The researchers looked at medical claims from over 13,000 commercially insured adults from the Medical Panel Expenditure Survey from 2001 to 2020 and found that medical spending was lower in those who weighed less. Therefore, cost effectiveness of an effective weight loss drug would be much higher in those with higher BMIs, especially in those with diabetes.
However, the study didn’t evaluate people who had lost weight, but rather examined differences in costs based on BMI. Those who lose weight won’t necessarily have the same lower level of expense as those who weren’t previously obese. Even if their estimate of cost “savings” is correct, the net cost of semaglutide or tirzepatide is around $9,000 annually, which is more than the delta in costs for a person with diabetes who loses 25% of their body weight.
Implications for employers:
The Gallup Organization recently reported that public opinion of the quality of U.S. healthcare has declined to its lowest point since they started asking this question in 2001. Only 44% of respondents say that quality of care in the U.S. is “excellent” (11%) or good (33%). Survey respondents rate coverage more negatively than quality. Only 28% of survey respondents say that coverage in the U.S. is excellent (6%) or good (22%).
Respondents rated their own personal healthcare quality and coverage substantially better, although these metrics are on a downward trend, too.
Cost of care was named as the most urgent health problem facing the country most often (23%), followed by access (14%) and obesity (13%). This survey was of 1,001 diverse adults, and results were weighted to be representative of the U.S. population.
Implications for employers:
JAMA recently published a summary of the striking decrease in deaths from cervical cancer among young women that began around 2015, when the first group of young women were protected by the human papilloma virus (HPV) vaccine. Cervical cancer deaths had been declining by about 3.7% a year from 1992–2015, and they decreased about 15.2% per year from 2015–21.
The rate of cervical cancer death was already decreasing, likely due to screening and better treatment of invasive disease. This decline increased dramatically from 2015 on, associated with the first group to have been protected by the HPV vaccination. The HPV virus also causes throat, head and neck cancers, although we won’t have data on its impact on population mortality for decades.
The Centers for Disease Control and Prevention (CDC) reported that 76% of young women had at least one dose of the HPV vaccine, and 62.6% were up to date (3 vaccinations) by 2022. Previous research showed that the HPV vaccine was linked to an 86% drop in cervical cancer if given between 14 and 16 years old. There were no cases of cervical cancer in those who were vaccinated before age 14. The HPV vaccine is currently recommended for adolescent boys and girls and has been shown to be safe. There’s no evidence that young teens who are vaccinated are more likely to engage in earlier sexual activity.
Implications for employers:
As a physician, I never saw a case of paralytic polio. As a Boy Scout, I had a scoutmaster who was one of the last people who became a paraplegic due to a childhood polio infection in the 1950s. Mitch McConnell may be one of the last elected officials who is a polio survivor. He has a paralyzed left leg from an infection when he was a toddler in the 1940s. In 1952, there were 21,000 cases of paralytic polio in the United States.
There have been no cases of domestic paralytic polio in the U.S. in three decades, although there were cases brought to the U.S. from abroad in 1993 and 2022. There have been no children paralyzed by polio in the U.S. because we have high rates of polio vaccination among young children. International travel could bring polio back to the U.S. if our vaccination rates fall.
The U.S. now uses an inactivated (killed) polio vaccine (IPV) administered as an injection. This vaccine can’t cause paralytic polio and stimulates the immune system to produce protective antibodies. The oral polio vaccine (OPV), which contains a weakened live virus, can in rare cases cause paralytic polio, but hasn’t been used in the U.S. since 2000. However, OPV is still used in some developing countries because it is cost-effective, doesn’t need needles and can help spread immunity to others through community transmission of the weakened virus.
Here are resources with information about polio vaccination:
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.