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- Title
Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss.
- Authors
Haseeb, Muhammad; Chhatwal, Jagpreet; Xiao, Jade; Jirapinyo, Pichamol; Thompson, Christopher C.
- Abstract
Key Points: Question: What is the cost-effectiveness viability of semaglutide compared with endoscopic sleeve gastroplasty (ESG) over 5 years for individuals with class II obesity? Findings: In this economic evaluation study using a Markov cohort model analysis, ESG was found to be a cost-effective strategy, offering greater weight loss and cost savings. The annual cost of semaglutide would need to be reduced 3-fold, from $13 618 to $3591, for it to be a cost-competitive alternative. Meaning: The study suggests that while semaglutide is effective for weight loss, it is not economically viable over the long term compared with ESG, which remains a cost-saving alternative for this patient population. Importance: Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy. However, their cost-effectiveness over an extended period compared with ESG is a critical gap that needs to be better explored for informed health care decision-making. Objective: To assess the cost-effectiveness of semaglutide compared with ESG over 5 years for individuals with class II obesity. Design, Setting, and Participants: This economic evaluation study, conducted from September 1, 2022, to May 31, 2023, used a Markov cohort model to compare ESG and semaglutide, with a no-treatment baseline strategy. The study comprised adult patients in the US health care system with class II obesity (body mass index [BMI] of 35-39.9). The base case was a 45-year-old patient with class II obesity (BMI of 37). Patients undergoing ESG were subjected to risks of perioperative mortality and adverse events with resultant costs and decrement in quality of life. Interventions: Strategies included treatment with semaglutide and ESG. Main Outcomes and Measures: Costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100 000/QALY. A 5-year time horizon with a cycle length of 1 month with a 3% discount rate was used. Probabilities, costs, and quality-of-life estimates of the model were derived from published literature. One-way, 2-way, and probabilistic sensitivity analyses were also performed. Results: The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of –$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33 583 relative to semaglutide. The results remained robust on 1-way and probabilistic sensitivity analyses. Endoscopic sleeve gastroplasty sustained greater weight loss over 5 years vs semaglutide (BMI of 31.7 vs 33.0). To achieve nondominance, the annual price of semaglutide, currently $13 618, would need to be $3591. Conclusions and Relevance: This study suggests that ESG is cost saving compared with semaglutide in the treatment of class II obesity. On price threshold analyses, a 3-fold decrease in the price of semaglutide is needed to achieve nondominance. This economic evaluaton study assesses the cost-effectiveness of semaglutide compared with endoscopic sleeve gastroplasty over 5 years for individuals with class II obesity.
- Subjects
UNITED States; BARIATRIC surgery; WEIGHT loss; RISK assessment; COST control; QUALITY-adjusted life years; COST effectiveness; BODY mass index; RESEARCH funding; SOCIOECONOMIC factors; MEDICAL care; DESCRIPTIVE statistics; GLUCAGON-like peptides; STOMACH surgery; LONGITUDINAL method; ENDOSCOPIC gastrointestinal surgery; QUALITY of life; COMPARATIVE studies; MEDICAL care costs; PERIOPERATIVE care
- Publication
JAMA Network Open, 2024, Vol 7, Issue 4, pe246221
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.6221