Individuals without diabetes who newly started glucagon-like peptide-1 (GLP-1) agonist drugs for obesity experienced an average of $4,206 higher cost of care in their second year, compared to like members not taking a GLP-1 drug for obesity. The study, by Prime Therapeutics, also shows that across the obesity-related outcomes included in the study, no reduction in medical events was observed over the first two years of therapy.
These findings are part of Prime's ongoing GLP-1 research, including a study that showed 85% of individuals taking GLP-1 drugs for weight loss no longer took the drug after two years.
"While individuals experience weight loss from taking a GLP-1 drug, in our real-world analysis, no further health benefit is observable after two years, and in fact, they end up with a substantially higher cost of care than those who are not taking the drug," said David Lassen, Vice President, Pharmacy Clinical Services at Prime.
In total, 3,346 commercially insured members newly initiating GLP-1 therapy, without T2DM and with a medical diagnosis of obesity and/or BMI ≥ 30, met final study criteria, and 396,103 control group members met all study criteria. From this group, 3,046 GLP-1 utilising members were matched to three control members for a total of 8,343 unique control members identified; 306 (3.7%) of controls matched to more than one GLP-1 utiliser.
The mean age of individuals identified was 46 years, 81% were women and 14% had a prediabetes diagnosis. Across the three study periods, total cost of care (TCC) for GLP-1 utilisers averaged $12,695, $20,165 and $18,507, in the pre-year, year one and year two, respectively. For the same study periods, TCC in the matched control group averaged $11,406, $11,882 and $13,012.
Comparing TCC between groups and across study periods, the difference-in-difference for year one vs. pre-year was $6,994 (p<0.0001) higher per GLP-1 treated member compared to control. The same TCC comparison for year two vs. pre-year was $4,206 (p<.0001) higher per GLP-1-treated member compared to control. The increasing number of members who did not persist on GLP-1 therapy from year one to year two explain the observed decrease in pharmacy spend and TCC.
They found no differences in medical spend trends were observed between groups. The rate of acute pancreatitis in year one compared to the pre-year was statistically higher for GLP-1-initiating members, with an increase from 0.1% pre-year to 0.6% in year one, compared to the matched control group, 0.3% pre-year and 0.4% in year one, for a difference-in-difference higher 0.4% GLP-1 incidence, p=0.019, translating to one additional acute pancreatitis event per 250 GLP-1 treated individuals.
The findings indicate in the real world that individuals taking GLP-1 therapies without diabetes will see no medical cost offset in their treatment over the two years but rather expect a total cost of care of US$11,200 per individual at two years at standard drug prices prior to discounts, with only 1 in 7 still taking a GLP-1 drug.
GLP-1 persistence and adherence to therapy was poor with 32% still on therapy at one year and 27% adherent to therapy, defined as PDC ≥ 80%. Year-two GLP-1 persistence worsened to 15% and adherence was 17%.
"The popularity of GLP-1 drugs as a treatment for obesity meets a sobering reality of poor adherence and high cost of care in the real world, and it may be quite some time before these measures and health metrics improve in any substantial way," commented Dr Marci Chodroff, vice president, Medical Director at Prime.
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