The Conventional Cost-Effectiveness and Distributional Cost-Effectiveness of Semaglutide for Obesity Treatment

This study aimed to evaluate the conventional and distributional cost-effectiveness of semaglutide, laparoscopic sleeve gastrectomy (LSG), and a "do nothing" option in Black and White racial subgroups.

A Markov simulation model was developed from a healthcare perspective over a 25-year time horizon for Black and White adults, aged 65-70, with BMI ≥ 35 and cardiovascular disease. Three interventions were modeled: semaglutide 2.4 mg, LSG, and "do nothing."

Semaglutide and LSG interventions are cost-effective compared to a "do nothing" strategy (ICERs = $7300/QALY and $12,100/QALY, respectively). Compared to semaglutide, LSG is more expensive but cost-effective (ICER = $53,700/QALY). Semaglutide is more equitable but is not distributionally cost-effective compared to LSG, because it has a lower EDE within our defined inequality aversion (ε) range. Across 10,000 probabilistic iterations, LSG has a 57% probability and semaglutide has a 43% probability of being the most cost-effective at the willingness-to-pay threshold of $100,000/QALY. Semaglutide becomes distributionally cost-effective when ε ≥ 14.72, where equity impacts of semaglutide outweigh the conventional cost-effectiveness outcomes.

LSG is the most conventionally cost-effective treatment option with some uncertainty. Semaglutide is marginally more equitable than LSG but is not a distributionally cost-effective strategy.