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A certain type of bariatric surgery may prove more cost-effective over time than a popular weight loss drug, an economic evaluation study suggested.

In an analysis of adults with class II obesity (BMI 35-39.9), endoscopic sleeve gastroplasty (ESG) added 0.06 more quality-adjusted life-years while costing $33,583 less than semaglutide (Wegovy) over 5 years, Christopher Thompson, MD, MSc, of Brigham and Women's Hospital in Boston, and colleagues found.

To be on par with sleeve gastroplasty in terms of cost-effectiveness over a 5-year span, the annual price of semaglutide would have to drop from $13,618 to $3,591, they estimated in .

The results suggest "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," the researchers wrote.

The findings also fall in line with the conclusions from an (ICER) analysis that the price of semaglutide needs to be lowered to be cost-effective compared with lifestyle modification, they added.

"The strategic choice of cost-saving yet effective treatment such as ESG compared with semaglutide for specific patient groups could help alleviate the potential budget strain expected from the use of semaglutide," Thompson and co-authors explained. "Given the high prevalence of obesity in the U.S., there is a growing need for cost-effective interventions that can be made accessible to the broader population -- to those without the ability to pay out of pocket or from limited use of effective interventions because of budget constraints -- to address the obesity pandemic."

The popular GLP-1 receptor agonist injectable was first approved in 2017 for type 2 diabetes under the trade name Ozempic, and was approved in 2021 at a higher 2.4 mg dose for chronic weight management under the name Wegovy. Last month, semaglutide 2.4 mg also picked up an indication to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight. With this new indication, Medicare announced it will cover the weight-loss formulation of semaglutide under its Part D drug program for this patient population.

In their economic evaluation, Thompson and co-authors used a base case of a 45-year-old patient with a BMI of 37 treated with two different strategies from September 2022 through May 2023. All costs were adjusted to 2022 U.S. dollars.

Clinical outcomes were based on the clinical trials testing both obesity treatment strategies: the STEP 1 trial of semaglutide and the MERIT trial of endoscopy sleeve gastroplasty. The semaglutide trial excluded all patients with type 2 diabetes, while the surgical trial conditionally included patients with diabetes.

Also considered in the analysis were adverse events associated with each of the two treatment strategies. This included patients on semaglutide stopping treatment due to medication intolerance and surgical patients running into issues such as surgical revision. With the minimally invasive, incisionless endoscopic procedure, surgical patients were assumed to have an initial quality-of-life decrement for the first week after surgery. Meanwhile, it was assumed around 20% of semaglutide patients wouldn't adhere to treatment.

For the base case, the surgical treatment yielded the most quality-adjusted life-years accumulated over 5 years: 3.55 for no treatment, 3.60 for semaglutide, and 3.66 for sleeve gastroplasty. Endoscopic sleeve gastroplasty sustained greater weight loss over this timeframe than semaglutide -- a BMI of 31.7 vs 33.0.

Endoscopic sleeve gastroplasty had an incremental cost-effectiveness ratio of -$595,532 per quality-adjusted life-year over a 5-year time horizon compared with semaglutide. Over 1 year, ESG was not cost-effective compared with semaglutide but when the horizon was extended to 2 years, ESG became cost-saving.

The analysis estimated cost-effectiveness in a patient with class II obesity and findings may not apply to milder cases of obesity or overweight, the researchers acknowledged. Thompson's group also said they didn't include improvement in comorbidities in their model from either treatment, like improvement in hypertension, hyperlipidemia, or type 2 diabetes.

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