Diabetes Obes MetabWeight LossMeta-AnalysisDecember 9, 2025

GLP-1 receptor agonists for treating obesity without diabetes: A systematic review and meta-analysis of economic evaluations.

Dhippayom T, Meraz M, Lee H, Hur C, Inadomi JM, Veettil SK, Dunn JD, Chaiyakunapruk N

Key Finding

A major economic analysis found that popular weight-loss drugs like semaglutide (Ozempic/Wegovy) and liraglutide (Saxenda) are not cost-effective for treating obesity in people without diabetes, with negative returns of $3,659 to $84,060 per patient depending on the comparison.

What This Study Found

Think of cost-effectiveness like buying a car - you want to know if the benefits you get are worth the price you pay. This study is like having 9 financial advisors analyze whether GLP-1 weight-loss drugs are worth their hefty price tags for people who want to lose weight but don't have diabetes. The researchers looked at studies from wealthy countries and used a special calculation called 'incremental net benefit' - imagine it as your financial gain after buying something expensive. If you spend $1,000 on a tool that saves you $1,200 in work, your net benefit is $200. But if that same tool only saves you $800, you're $200 in the hole. The results were sobering: compared to doing nothing, semaglutide showed a loss of $3,659 per patient, while liraglutide showed a much steeper loss of $32,032 per patient. When compared to basic lifestyle changes (diet and exercise programs), the losses were even more dramatic - $84,060 for semaglutide and $70,563 for liraglutide. It's like paying luxury car prices for economy car benefits.

Statistics Decoded

The 95% confidence intervals tell us where the real cost-effectiveness probably lies - for semaglutide vs. no treatment, we're pretty sure the true cost is somewhere between losing $74,379 and gaining $67,062 per patient, but the average suggests a $3,659 loss. The I2 statistic measured how much the different studies disagreed with each other (though the specific value wasn't reported). The negative incremental net benefits mean these drugs cost more than the health benefits they provide are worth - like buying a $50,000 car that only gives you $20,000 worth of transportation value.

Why This Matters

This analysis suggests that insurance companies and healthcare systems may struggle to justify covering these expensive weight-loss medications for people without diabetes, potentially limiting access despite their proven effectiveness. However, the authors hint that longer-term studies and consideration of broader health benefits beyond just weight loss might change this economic picture.

Original Abstract

To pool the incremental net benefits (INBs) of using glucagon-like peptide-1 receptor agonists (GLP-1RAs) for treating obesity without diabetes. PubMed, Embase, EconLit, CEA Registry, ProQuest Dissertation and Theses Global were searched from inception to April 2024. Cost-effectiveness studies were included if they reported economic outcomes of any GLP-1RAs in the treatment of obesity without diabetes for a minimum time horizon of 5 years. Details of the study characteristics, economic model inputs, costs, and outcomes were extracted. Monetary units were converted to 2023 US dollars. INBs with 95% confidence interval (CI) were pooled using a random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic. The outcome was INB, calculated by multiplying the willingness-to-pay threshold by the difference in effectiveness between two interventions, then subtracting the difference in costs, with a positive INB indicating cost-effectiveness. Of 634 studies identified, 9 from high-income countries (HICs) with 23 comparisons were included. The pooled INB demonstrated that semaglutide and liraglutide were not cost-effective compared to no intervention (-$3659 [95% CI, -$74 379 to $67 062] and -$32 032 [95% CI, -$101 534 to $37 488], respectively) and lifestyle interventions (-$84 060 [95% CI, -$152 645 to -$15 475] and -$70 563 [95% CI, -$106 520 to -$34 605], respectively). GLP-1RAs are generally not cost-effective for obesity treatment in patients without diabetes in HICs from a healthcare/payer perspective. However, they may be cost-effective in subgroups evaluated over longer time horizons. Most included studies focused on weight-related outcomes, potentially underestimating the broader economic value of GLP-1RAs. This pooled economic evidence may inform the decision-making process.