Researchers from the University of Chicago modeled the clinical and financial impact of anti-obesity medications: Zepbound (tirzepatide), Wegovy (semaglutide) and two oral generic drug combinations, phentermine-topiramate and naltrexone-bupropion. They compared the effectiveness of each of these drugs with each other and with lifestyle change alone.
In their simulation model, they used data from 4,823 adults in the 2017–20 National Health and Nutrition Examination Survey (NHANES), who represent 126 million eligible U.S. adults who met the criteria for anti-obesity therapy, i.e., either BMI>=30 or BMI>=27 with a metabolic complication. They found that the cost of tirzepatide was about $197,000 per additional quality-adjusted life year (QALY), and the cost of semaglutide was about $468,000 per QALY. In general, drugs should cost under $100,000 or $150,000 per QALY to be considered cost-effective. They found that Zepbound’s net price would have to drop by 31% and Wegovy’s net price would have to drop by 82% for these drugs to be affordable at $100,000 per QALY.
Generic anti-obesity drugs are cost-saving (naltrexone-bupropion) or cost-effective (phentermine-topiramate).
This study was done in late 2024, but there are some clinical benefits of GLP-1 medications that the researchers didn’t include in this model. For example, we know that GLP-1 drugs lower the risk of progression of kidney disease in those with diabetes, lower the risk of obesity-related cancers and lower the risk of steatohepatitis (fatty liver disease). These drugs also are helpful for people with sleep apnea, which is associated with high blood pressure and increased cardiac risk. Including these benefits in the microsimulation model would have made the GLP-1 drugs look a bit more cost-effective.
The researchers included the costs of medication, other medical therapy and worker productivity in their analysis.
The clinical results of both GLP-1 drugs, especially tirzepatide, are impressive. According to the model, a population of 100,000 people on tirzepatide had over 46,000 fewer cases of obesity and 32,000 fewer cases of diabetes than a population treated with only a lifestyle management program. Semaglutide achieved substantial but smaller clinical benefits. Benefits from the generic drugs were much smaller, although their low costs made them more cost-effective.
Another way to look at this is how many people needed to be treated to prevent a premature cardiovascular or diabetes-related death. This helps give a sense about just how much more effective the GLP-1 medications are compared to the generic combination medications.
Automated insulin delivery systems (AID) are becoming more common among people with Type 1 diabetes. These systems use a glucose monitor to give insulin at regular intervals. Type 1 diabetes patients produce almost no insulin and would die without insulin therapy. However, these systems aren’t as commonly used in those with Type 2 diabetes (T2D). T2D is over twenty times as common as Type 1, and often (although not always) affects those who are older and overweight or obese.
Researchers randomized 319 people with Type 2 diabetes (T2D) who were getting insulin treatment to either have an AID or be maintained on their previous insulin therapy. This was a short study (13 weeks) that showed that AID was safe when used in T2D. It also led to lower hemoglobin A1C (HbA1C) levels, a sign of better diabetes control. Patients with AID also had blood sugar in the target range for longer, 64% of each day, compared to 52% of each day for those without AID.
A “pink tax” refers to products or services marketed to women that are priced higher than identical products marketed to men. GoodRx recently posted a study looking at medications filled by women and men and found that women spend nearly 30% more out of pocket on prescriptions, totaling $8.5 billion more ($39.3 billion by women versus $30.5 billion by men) in 2024.
The higher spending was due to several reasons. First, women see their healthcare providers more often. Second, women have a higher burden of diseases and conditions overall and fill more often and more expensive medications. Third, women outspend men, particularly in depression and anti-anxiety treatments. Lastly, there are some conditions that affect only the female anatomy, like endometriosis, which raise overall costs for women.
The highest difference in costs of medications between women and men came in the age group of 18–44 years, prime years in the workforce. In some years within this age range, the difference in spend was up to 64% higher for women. The only age range where men consistently outspent women was in boys under age 18 years, likely due to higher rates of ADHD diagnosis and treatment in boys.
Women also spend more to maintain and improve their health than men, according to this GoodRx report. That ongoing care might lead to earlier diagnoses and less productivity loss. While this excess spending among women isn’t a traditional “pink tax,” it’s another way that women face higher healthcare expenses than men.
JAMA says that breast cancer and colorectal cancer screening rates that went down during the pandemic are now back to the levels before the pandemic. However, screening for cervical cancer is still lower than in 2019. Cervical cancer screening increased post-pandemic in those with a college education but decreased in those with a high school degree or less education. The researchers used data from the National Health Interview Survey. This survey has many questions about different types of colorectal cancer screening. However, this survey tool often reports lower colorectal cancer screening rates than are reported in claims-based analysis. The National Committee for Quality Assurance (NCQA) reports that 59.2% of eligible adults were up to date on colorectal cancer screening in 2023.
The researchers didn’t investigate rates of screening for lung cancer. Lung cancer screening rates are abysmally low; only 6% of those currently eligible get appropriate lung cancer screening.
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.
Plan redesign outweighs cost-shifting to reduce the cost of care, WTW survey finds
