Long-Term Weight Loss: Which Wins? Endoscopic Sleeve Gastroplasty vs. Semaglutide (Cost Breakdown Included!)

A US healthcare perspective economic evaluation compared the cost-effectiveness of endoscopic sleeve gastroplasty (ESG) and semaglutide for class II obesity over five years. A state-transition Markov cohort model analyzed costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The study in JAMA Network Open found ESG to be the more cost-effective strategy, leading to greater weight loss and lower costs compared to semaglutide. Notably, semaglutide's price would need a substantial decrease to compete with ESG. The model incorporated real-world data but did not explicitly explore potential improvements in obesity-related comorbidities. While limitations exist, the study suggests ESG is a more cost-effective option for long-term weight loss in class II obesity patients within the US healthcare system.

Key Points

1. Burden of Obesity and Treatment Landscape in the US

• Obesity is a major health concern in the US, with a projected prevalence of nearly 50% by 2030.

• It is linked to numerous chronic health conditions and imposes a significant burden on healthcare systems, with direct medical expenses exceeding $260 billion in 2016.

• Traditional management options include lifestyle interventions and bariatric surgery.

• Lifestyle changes are challenging to maintain and have limited effectiveness.

• Bariatric surgery is highly effective but might be perceived as invasive, expensive, or with limited insurance coverage.

2. Enter Minimally Invasive Solutions and New Medications

• Recent advancements offer minimally invasive endoscopic bariatric and metabolic therapies as an alternative to traditional bariatric surgery.

• Endoscopic sleeve gastroplasty (ESG) has gained significant attention for its effectiveness. It reduces stomach volume and alters gastric motility to promote satiety and weight loss.

• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), like semaglutide, represent another development. These medications mimic a natural gut hormone that delays gastric emptying, leading to increased satiety and reduced appetite.

• Semaglutide has gained popularity due to its ease of use (weekly injections) and demonstrated effectiveness in weight loss.

3. Cost-Effectiveness as a Crucial Consideration

• While both ESG and semaglutide show promise in weight management, their long-term cost-effectiveness is crucial.

4. Study: Comparing Costs and Benefits of ESG vs. Semaglutide

• A recent economic evaluation study compared the cost-effectiveness of ESG and semaglutide for class II obesity over five years.

• It analyzed costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER).

5. ESG Emerges as the More Cost-Effective Option

• The study found ESG to be the more cost-effective strategy.

• It resulted in greater weight loss than semaglutide and offered significant cost savings over five years.

• For semaglutide to be cost-competitive, its price would require a substantial reduction.

6. Model Details and Methodology

• The study employed a state-transition Markov cohort model to assess cost-effectiveness.

• It simulated a cohort of patients with class II obesity over five years.

• The model factored in costs associated with various aspects and incorporated quality-of-life adjustments based on weight changes and potential side effects.

7. Key Takeaways and Considerations

• ESG offers a more cost-effective solution for weight loss in class II obesity compared to semaglutide over five years.

• Semaglutide's current price is a significant factor in its cost-effectiveness.

• ESG might offer additional benefits beyond weight loss, potentially leading to further cost savings.

• The study acknowledges limitations, such as limited comorbidity data and data timeframe.

• The decision ultimately rests on a discussion between patients, healthcare providers, and insurance companies.

• Beyond cost-effectiveness, factors like patient preferences, eligibility, and insurance coverage influence treatment decisions.

Shedding Pounds and Saving Dollars: A Deep Dive into Endoscopic Sleeve Gastroplasty vs. Semaglutide for Long-Term Weight Loss

Obesity is a growing global concern, impacting millions and imposing a significant burden on healthcare systems. In the US alone, the estimated prevalence is projected to reach nearly 50% by 2030. Tackling this issue requires exploring various treatment options, and this blog post delves into the cost-effectiveness of two such options for individuals with class II obesity (body mass index [BMI] of 35-39.9) over a five-year period: endoscopic sleeve gastroplasty (ESG) and semaglutide.

The Burden of Obesity and the Treatment Landscape

Obesity is a complex disease linked to numerous chronic health conditions like diabetes, heart disease, and certain cancers. It not only impacts quality of life but also translates to staggering healthcare costs. In the US, direct medical expenses linked to obesity were estimated at a staggering $260 billion in 2016.

Traditionally, managing obesity involved lifestyle interventions and bariatric surgery. Lifestyle changes, while crucial, often face challenges due to difficulty in maintaining them and limited effectiveness. Bariatric surgery, on the other hand, presents a more drastic approach. While highly effective, some patients might hesitate due to perceived invasiveness, cost, or limited insurance coverage.

Enter Minimally Invasive Solutions and New Medications

Recent advancements have brought forth endoscopic bariatric and metabolic therapies as a promising alternative. These procedures offer a minimally invasive and potentially safer approach compared to traditional bariatric surgery. ESG, in particular, has garnered significant attention for its effectiveness. Performed endoscopically (through small incisions), it reduces stomach volume and alters gastric motility to promote satiety and weight loss.

Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), represents another exciting development. These medications mimic a natural gut hormone that delays gastric emptying, leading to increased satiety and reduced appetite. Semaglutide, in particular, has gained popularity due to its ease of use (weekly injections) and demonstrated effectiveness in promoting weight loss.

Cost-Effectiveness: A Crucial Consideration

While both ESG and semaglutide show promise in weight management, their long-term cost-effectiveness remains a crucial question. This blog post sheds light on this aspect by analyzing a recent economic evaluation study.

The Study: Comparing Costs and Benefits of ESG vs. Semaglutide

The study compared the cost-effectiveness of ESG and semaglutide over five years for individuals with class II obesity. It utilized a model to analyze costs, quality-adjusted life-years (QALYs, a measure of health-related quality of life), and the incremental cost-effectiveness ratio (ICER).

ESG Emerges as the More Cost-Effective Option

The study found ESG to be the more cost-effective strategy. It not only resulted in greater weight loss compared to semaglutide but also offered significant cost savings over the five-year period. Interestingly, for semaglutide to become cost-competitive, its price would need to be reduced by a substantial margin.

ESG's Advantages: Beyond Cost

The study's findings highlight ESG's potential as a cost-saving and effective weight-loss solution. Additionally, ESG might offer other advantages not captured in the study, such as potential improvements in obesity-related health conditions, leading to further cost reductions in the long run.

Model Details and Methodology

The study employed a state-transition Markov cohort model to assess the cost-effectiveness of ESG and semaglutide. The model simulated a cohort of patients with class II obesity over five years. Here's a deeper dive into the methods used:

• Base Case: A 45-year-old patient with class II obesity (BMI of 37) served as the base case.

• Competing Strategies: The model compared three strategies:

  • No treatment

  • Semaglutide treatment

  • ESG treatment

• Data Sources: Clinical data for the first year were derived from randomized clinical trials (STEP 1 for semaglutide and MERIT for ESG). Data for subsequent years came from published studies and publicly available sources.

• Model Time Horizon: The model simulated the outcomes over five years.

• Cost Considerations: The model factored in the costs associated with:

  • No treatment (assumed to be zero)

  • ESG procedure (including repeat procedures if needed)

  • Adverse events from ESG

  • Monthly cost of semaglutide

  • All costs were adjusted to 2022 US dollars.

• Quality-of-Life Adjustments: The model incorporated adjustments in quality of life based on weight changes and potential side effects from procedures or medication intolerance.

Outcomes of the Economic Evaluation

The primary outcomes of interest in the study were:

• Quality-Adjusted Life Years (QALYs): This metric combines both the length of life and the quality of that life. The study found that patients in the ESG group accumulated the highest QALYs (3.66) over five years, followed by semaglutide (3.60) and no treatment (3.55).

• Total Costs: The study revealed that the no-treatment group had the lowest cost ($0), followed by ESG and then semaglutide. Interestingly, despite the initial procedure cost, ESG emerged as the more cost-effective option in the long run.

• Incremental Cost-Effectiveness Ratio (ICER): This metric compares the additional cost of one intervention compared to another relative to the additional health benefit gained. The study found that ESG had a negative ICER, indicating it was both more effective (in terms of QALYs) and less expensive than semaglutide over the five-year period.

Sensitivity Analyses: Ensuring Robustness

The study went beyond the base case to ensure the reliability of its findings by conducting sensitivity analyses. These analyses explore how changes in model assumptions might influence the results. Here's a breakdown of the methods used:

• One-way Sensitivity Analysis: This analysis varies one parameter at a time within a set range to assess its impact on the ICER. The study found that ESG remained cost-effective across all tested parameters.

• Two-way Sensitivity Analysis: This analysis explores how simultaneous changes in two parameters might influence the ICER. The study found that even with significant reductions in semaglutide cost or increases in ESG costs, ESG remained the more cost-effective option.

• Probabilistic Sensitivity Analysis: This analysis accounts for the inherent uncertainty in various model parameters by incorporating probability distributions. The study found that ESG remained cost-effective with a high probability (almost 100%) over the five-year horizon.

Understanding the Results: Key Takeaways

The study's findings offer valuable insights for patients, healthcare professionals, and policymakers:

• ESG Demonstrates Long-Term Cost-Effectiveness: For patients with class II obesity, ESG offers a more cost-effective solution for weight loss compared to semaglutide over a five-year period. This is due to both its greater weight loss effectiveness and lower overall costs.

• Semaglutide's Price Point Matters: The study suggests that semaglutide's current price would need a significant reduction to become cost-competitive with ESG.

• ESG May Offer Additional Benefits: While not directly captured in the study, ESG might offer additional benefits beyond weight loss, such as improvements in obesity-related health conditions, potentially leading to further cost savings in the long run.

Limitations and Considerations

The study acknowledges some limitations:

• Limited Comorbidity Data: The model did not explicitly explore the potential improvements in obesity-related comorbidities like diabetes or heart disease with either treatment. However, it accounted for this by incorporating BMI-specific mortality data.

• Data Timeframe: The study relied on data available at the time, limiting the long-term data available for both strategies. However, it prioritized using real-world data to maintain accuracy.

• Microlevel Follow-up Costs: The model did not account for potential differences in follow-up clinic visit costs. However, this is unlikely to significantly impact the overall cost-effectiveness results.

Conclusion: Weighing the Options

This blog post has explored the cost-effectiveness of ESG and semaglutide for weight loss in class II obesity. The study suggests that ESG offers a more cost-effective approach over five years. However, the decision ultimately rests on a comprehensive discussion between patients, healthcare providers, and insurance companies, considering individual needs, preferences, and overall health status.

Additional Considerations

Beyond cost-effectiveness, other factors might influence treatment decisions:

• Patient Preferences: Some patients might prefer the minimally invasive nature of semaglutide injections compared to the surgical procedure of ESG.

• Eligibility: Not all patients qualify for ESG due to underlying medical conditions.

Insurance Coverage: Insurance coverage for both treatments can vary.

Journal Reference

Haseeb, M., Chhatwal, J., Xiao, J., Jirapinyo, P., & Thompson, C. C. (2024, April 12). Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss. JAMA Network Open, 7(4), e246221. https://doi.org/10.1001/jamanetworkopen.2024.6221

Related

https://healthnewstrend.com/the-transformative-power-of-hiit-for-overcoming-obesity

Disclaimer

The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.