Old Woman Examining a Coin

Looking for Endoscopy to Save Money on GLP-1s

Right now GLP-1 medicines for obesity carry high list prices that engender great debates about how many billions (hyperbolists will say trillions) of dollars treating obesity will cost healthcare systems. For the uninitiated, it’s quite natural to think of metabolic procedures and obesity medicine in terms of either/or questions. No matter that this is a false dichotomy. So it is not at all surprising to see a new paper in JAMA Network Open telling us that endoscopy could save money as an alternative to GLP-1s.

Specifically, Muhammad Haseeb and colleagues conclude:

“This economic evaluation study suggests that ESG is cost saving compared with semaglutide for class II obesity. This finding is due to the increased effectiveness and lower costs of ESG and the increased dropout rates over time with semaglutide. The annual price of semaglutide must decrease by more than 3-fold to achieve non-dominance with ESG.”

Take note of that last bit. The authors are saying the list price of semaglutide is three times too high versus endoscopic sleeve gastrectomy (ESG).

Endoscopy Ready for Prime Time?

Endoscopic sleeve gastroplasty is a relatively new metabolic procedure. In a 2022 review article, Ann Rogers and Eric Pauli wrote that “the available evidence suggests that ESG is ready for prime time, but with some caveats.”

Endoscopic sleeve procedures are generally less invasive and costly that laparoscopic sleeve surgeries. But they also tend to be somewhat less effective. Also, being a newer procedure, the data on long-term outcomes is not as robust as it is for surgical sleeve procedures.

So although ESG looks like a good option, we have more to learn.

The False Choice

This new paper offers really good perspective – for the most part. It is quite reasonable to think that ESG can improve the value-for-money calculus in obesity care. It may well be that endoscopy can help to save money on GLP-1s. However, two notes of caution are worth making.

First, this is an apples-to-oranges comparison on prices. For their modeling, these authors use list price for semaglutide and actual costs for ESG procedures. But paying full list price for semaglutide is rare. Though the lack of pricing transparency makes it hard, it is reasonable to think that net prices paid for semaglutide are in the range of half of the list price.

Second, treating obesity is seldom a one-and-done proposition. For optimal health, ongoing comprehensive care is necessary. That means that the construct of either a metabolic procedure or an obesity medicine is false. Many people will need multiple interventions and the course of care will be different for every patient. Cookie cutter economic analyses can thus be quite misleading.

Regardless, the message from this study is quite clear. Metabolic endoscopy procedures will likely become an important option because they can enhance the value delivered by obesity care. This is indisputably good news.

Click here for the study in JAMA Network Open and here for further reporting on it. For added perspective on ESG, Click here, here, and here.

Old Woman Examining a Coin, painting by Gerard van Honthorst / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


April 16, 2024