An Economic Doom Loop for Obesity Care

LoopingA pair of thoughts kept floating through the halls of ObesityWeek 2022 and they set up something that seems like an economic doom loop for the future of obesity care. The new drugs for obesity are amazing. But they’re too damn expensive.

Professor John Cawley gave an excellent presentation on the economics of obesity that likely sparked a lot of this dialogue. Obesity medicine physician Mike Albert summarized it in a tweet:

“The direct and indirect costs of obesity are significant, but we cannot bankrupt our society to pay for treatments.”

An Odd Pricing Loop

When you stop to think, it’s odd that obesity meds are caught in this weird pricing loop. Lots of people are living with obesity and would love to overcome it. But for a wide range of reasons, doctors are slow to prescribe obesity meds, patients are slow to demand them, and payers exploit the situation to keep a lid on it.

So here we are. Prices for the newest and best obesity meds are relatively high ($1,350 per month for Wegovy in the U.S.), in large part because so few people take them. But it works the other way around, too. Few people take them because the price is so high and most of the time, people have to pay out of pocket.

Specialty Pharma Pricing for a Common Disease

Thus, right now, one of the most effective treatments for one of the most common chronic diseases in the U.S. winds up being used very sparingly – as if it were a specialty drug for a very rare disease. Because the use is so low, the price is high. And because the price is high, the use remains low. The high price sets up an economic doom loop for obesity care so that very few people have access to advanced medicine that can be critical for overcoming it.

Historical Perspective

This is a loop we can escape. For perspective, Sir Stephen O’Rahilly’s summary of the recent Royal Society conference on causes of obesity is quite relevant:

“When I was a junior doctor in London and Dublin, our wards were full of people suffering the end-stage consequences of uncontrolled hypertension – intracranial hemorrhages, heart failure, renal failure. That problem has pretty much disappeared. We did it slowly and gradually over 40 years. It was a combination of public health measures and smart, safe pharmacotherapy.

“Back in the 1920s and 1930s, we didn’t have any antihypertensive drugs. The first drugs that came in (like guanethidine) had horrible, terrible side effects. And people said ‘we can never treat blood pressure because these drugs are awful.’

“How did we make better drugs? Well we started to understand the system. We understood the physiology of renin-angiotensin, we understood the importance of the kidney in the control of blood pressure.

“Now we have at least five classes of antihypertensive agents, all of which are cheap as chips because they’re all off patent. And there’s pretty much nobody whose blood pressure we can’t control.”

Cheap as chips. This reminds us that liraglutide – the first GLP-1 for obesity – comes off patent next year. Others will follow. Prices will come down and more people will enjoy better health because they will be better able to cope with this chronic disease of obesity.

So we have many reasons to be confident we can reduce the barriers to obesity care and get out of the economic doom loop our dysfunctional health systems have set for us.

Click here for more perspective on reducing barriers to obesity treatment. If you want to revisit a time when the health system withheld ACE inhibitors for hypertension because they were too darn expensive, click here.

Looping, painting by Félix Del Marle / WikiArt

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November 6, 2022