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GLP-1 treatment for obesity without diabetes raises total health care costs over two years without delivering medical cost offsets or event reduction.
Glucagon-like peptide-1 (GLP-1) medications—widely promoted for weight loss after years of use in diabetes—are driving higher health care spending without measurable medical cost savings during the first two years of treatment, according to new real-world evidence from "Prime Therapeutics".
To examine the real-world economic and clinical impact, researchers evaluated integrated medical and pharmacy claims from 16 million commercially insured individuals. The study focused on adults with obesity or a documented body mass index (BMI) of at least 30 who initiated GLP-1 therapy in 2021, had no diagnosis or treatment for diabetes, and were continuously enrolled for 1 year before and 2 years after commencing therapy. Those with serious comorbid ailments, including cancer and end-stage renal disease, were excluded.
A total of 3,346 GLP-1 initiators fulfilled eligibility criteria. Using a two-step matching process that accounted for demographics, comorbidities, insurance type, baseline medication use, and health care utilization, 3,046 GLP-1 users were matched to 8,343 control members who did not use GLP-1 therapy. In the matched cohort, the mean age was 46 years; females accounted for 81%, and prediabetes was identified in 14% at baseline. Total cost of care—defined as combined medical and pharmacy spending—rose substantially after GLP-1 initiation.
Among GLP-1 users, average annual costs escalated from $12,695 in the year prior to treatment to $20,165 in the first year and $18,507 in the second year. In contrast, matched controls had far lower and more stable costs, averaging $11,406 pre-index, $11,882 in year one, and $13,012 in year two. After adjusting for baseline differences, GLP-1 initiation was linked with an additional $6,994 per person in total costs in the first year and $4,206 in the second year, when compared with controls.
Investigators noted that the modest cost decline in year two among GLP-1 users was driven by reduced pharmacy spending as more patients discontinued therapy. Medical spending patterns remained comparable between groups, indicating no downstream cost offsets. Persistence and adherence to therapy were notably poor. Only 32% of patients remained on GLP-1 treatment at one year, and just 27% met adherence thresholds. By the end of year two, persistence fell to 15%, with adherence at 17%, meaning fewer than 1 in 7 patients continued therapy long term.
Clinical outcomes also failed to exhibit benefit over the two-year period. Rates of bariatric surgery, major adverse cardiovascular events, joint replacement, novel diabetes diagnoses, and medication changes for hypertension or cholesterol did not differ meaningfully between GLP-1 users and controls. However, a safety signal emerged in the first year of treatment. The incidence of acute pancreatitis among GLP-1 users rose from 0.1% before treatment to 0.6% in year one, compared with a smaller rise from 0.3% to 0.4% in controls.
This translated to one additional case of acute pancreatitis for approximately every 250 patients treated. Overall, the findings suggest that for those with obesity but without diabetes, GLP-1 therapy does not decrease health care costs or obesity-related medical events during the first two years of treatment. Instead, employers and health plans must anticipate an estimated $11,200 increase in per-person spending over two years, alongside low long-term persistence and a modest increase in pancreatitis risk.
Prime Therapeutics
Real-World Analysis of Glucagon Like Peptide-1 (GLP-1) Agonist Obesity Treatment Year-Two Clinical and Cost Outcomes
Patrick Gleason et al.
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