Friday, June 2, 2023
Will Anti-Obesity Drugs Bankrupt Health Systems?
With the recent introduction of the new class of highly-effective incretin-based anti-obesity medications, we have seen a lot of hand-wringing about the prohibitive costs that would incur, if even a fraction of those who may stand to benefit, were treated.
These assessments are of course based on current costs, which for Semaglutide 2.4 mg (Wegovy) in the US, can run up to $16,000 per year (albeit it is likely to be far less expensive in other countries).
Current costs, however, are not the final word in pricing – rather, I can foresee several factors that will eventually drive prices down (despite apparently limitless demand).
For one, we can expect that competition will have its effect (although this may not be immediately apparent).
Over time, patents will expire and less expensive generic versions will appear – for e.g. liraglutide goes off patent this year.
Oral forms of these medications will further reduce the logistical cost and hassles of cool-chains and devices.
Small-molecules, that are easier to mass-produce than biologics, will further decrease cost.
Given their potency, not everyone is going to need to be on the highest dose of these meds.
Negotiations with payers (rebates) will likely land on more reasonable prices.
Finally, as with all chronic diseases, only a fraction of eligible individuals will ever be on these medications for very long (even if they probably should be).
Thus it is probably only a matter of time (probably a few years), before the cost of medically treating obesity falls to that of managing other chronic diseases like diabetes or hypertension.
If we also factor in the potential healthcare savings from effectively treating obesity and reducing related complications (including heart disease and cancer), the economic picture certainly appears a lot less bleak than presented in most current projections.
Disclaimer: I have received honoraria as an independent medical, research and/or educational consultant from various companies including Aidhere, Allurion, Boehringer Ingelheim, Currax, Eli-Lilly, Johnson & Johnson, Medscape, MDBriefcase, Novo Nordisk, Oviva and Xenobiosciences.