Heart Lacy

Preventing Heart Attacks, Strokes, and Deaths by Treating Obesity

How much might the application of new insights from the SELECT study of treating obesity do for preventing heart attacks, strokes, and deaths. A first pass at answering this question appeared in Cardiovascular Drugs and Therapy last week. Nathan Wong, Hridhay Karthikeyan, and Wenjun Fan estimated the potential for semaglutide treatment to lower cardiovascular disease (CVD) risks in 93 million U.S. adults who might be appropriate candidates for treatment. They concluded:

“Semaglutide treatment in eligible US adults may substantially reduce obesity prevalence and CVD events, which may dramatically impact associated healthcare costs.”

Estimates Predating Full SELECT Results

We note that this estimate results from informed speculation of the effects that weight reduction should have on CVD. Not the results of the SELECT trial, which will not be fully available until this fall.

Nonetheless, the topline results from SELECT tell us that these are reasonable numbers. Wong et al estimated that semaglutide would prevent 1.5 million cardiovascular events, which represents an 18% reduction over ten years. The SELECT study demonstrated a 20% reduction in events over five years.

The Value Equation

Prior to having a full understanding of semaglutide’s effect on cardiovascular outcomes, health economists and payers are having a tough time with justifying the value that semaglutide offers at its list price of $1,349 per month for obesity treatment. In its 2022 evidence report on obesity treatment, the Institute for Clinical and Economic Review (ICER) concluded that the price of Wegovy (semaglutide) is twice as high as it should be in order to deliver good value for money. Note that PBMs reportedly get 50% or more off the high list price of Wegovy. But these contract prices are completely non-transparent.

Furthermore, in its final report, the Institute noted that cardiovascular outcomes data could yield a more positive assessment for semaglutide:

“Although not evaluated in our model, additional cardiovascular benefits, if present for GLP-1 receptor agonists in patients without diabetes mellitus, could result in improved cost effectiveness of treatment with semaglutide and liraglutide.”

So it was no big surprise when ICER told us last week that they “will be updating” their cost effectiveness analysis for semaglutide as soon as the full data from SELECT become available.

The Price Negotiation

All of this amounts to a big, awkward, and not-so-transparent price negotiation. The value of new obesity medicines is high and so are the prices.

How fast can we bring the costs into line with the value that these drugs offer? We’ve been here before. As recently as 20 years ago, health economists were saying that ACE inhibitors were just too expensive for first-line treatment in hypertension. Today, most people get them feely because they’re cheap as dirt.

How long will it take for this to happen with advanced obesity medicines? We cannot say. But it must. And true innovators will find a way, sooner rather than later.

Click here for the report from Wong et al, here for their press release, and here for the full ICER report on the economic and clinical value of obesity medicines.

Heart Lady, illustration by Raphael Kirchner / WikiArt

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August 21, 2023