Semaglutides (Ozempic and Wegovy), have been available for diabetes since 2017. Tirzepatides (Mounjaro and Zepbound) are newer and also used for weight lowering. Notably, tirzepatides decrease the chances of dying from heart disease and stroke according to a November 2023 New England Journal of Medicine (NEJM) lead article.
First the facts and then the financial implications to help understand how life seems to be changing from traditional approaches to weight loss to using modern technology to address diseases and overabundance.
“In this randomized, placebo-controlled trial involving patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months,” is the concluding sentence of the NEJM article.
More than half of the world’s population was expected to be overweight or obese by 2023. The consequences are excessive heart attacks and strokes that result in lower life expectancies. The semaglutides are advertised on TV, internet, and radio with catchy phrases, music, and commercials. Initially, the drugs were directed at reducing cardiovascular events for diabetics. Avoiding complications is not only better for patients by averting suffering but also lowers the cost of additional care and unnecessary disability.
So far, all good news about the efficacy of a new class of medications. What has attracted attention is the cost of the medication. In the “old days,” people went on diets, exercised, joined others similarly motivated people, and had modest long-term success. The cost of these conventional behavior modifications was modest, but the cardiovascular diseases continued unabated.
In the US today more than 41% of adults are obese costing at least $174 billion in annual excess health care spending according to a NEJM Perspective in March 2023. The yearly cost of the new generation of weight loss drugs is about $13,618 per year. Although some private insurers and state Medicaid programs cover the cost, the biggest payer is the Federal government’s Medicare Part D.
What is or will be the cost-effectiveness of this new class of medication? The Institute for Clinical and Economic Review (ICER) did the “homework” for a 45-year-old patient for medicines as compared with lifestyle modification. ICER’s conclusion was lifestyle modification is a better option. This study was completed before the above NEJM paper was published showing the decrease in cardiovascular events which are financially costly. Now, with the savings of avoiding heart attacks and strokes, the economic benefits of medications should be reevaluated. Contemporaneously, the cost of the medications has decreased modestly.
The profit-generating merry-go-round of marketing excess calories continues unabated. Recognizing the beneficial effects of semaglutide and tirzepatid to avoid cardiac and neurological complications has been well documented. Changing the support away from the food industry to the prevention of vascular disasters will not only decrease expenses for society but will also avoid misery and premature death.
