Expanding access to GLP-1 weight-loss drugs could save thousands of lives

By Tarun Sai LomteReviewed by Susha Cheriyedath, M.Sc.Oct 16 2024

Expanding access to obesity medications would significantly lower mortality rates, particularly in high-obesity states, saving over 50,000 lives yearly and improving health equity across the nation.

Study: Estimating the lives that could be saved by expanded access to weight-loss drugs. Image Credit: Douglas Cliff / Shutterstock

In a recent study published in the journal Proceedings of the National Academy of Sciences, researchers estimated the potential reduction in mortality through increased access to weight loss medicines. Obesity remains a major health crisis in the United States (US). It is also a risk factor for several chronic illnesses, including cancer, cardiovascular disease, and diabetes, and poor medical outcomes from nosocomial infections, infectious diseases, and surgical-site infections. The burden of obesity disproportionately affects economically disadvantaged groups, further entrenching health disparities in the US.

Obesity also mounts an immense economic burden, with medical costs projected to exceed $170 billion yearly. Obese individuals from lower socioeconomic backgrounds face additional healthcare costs, spending, on average, over $1,800 more annually than those without obesity.

It has been a remarkable discovery that drugs for managing diabetes can induce weight loss. These medicines, e.g., tirzepatide, semaglutide, and liraglutide, have been markedly effective in clinical trials, leading to weight loss. Semaglutide was initially approved for type 2 diabetes in 2017, but its use was expanded for chronic weight management in 2021. Similarly, tirzepatide was approved for chronic weight management in late 2023.

However, access to these medicines remains a significant barrier to addressing the obesity epidemic in the US. A combination of high drug costs, supply constraints, and restrictive insurance coverage policies drives this limited access. The limited supply, high costs, and lack of insurance coverage of tirzepatide and semaglutide limit their accessibility. The monthly cost of these drugs could exceed $1,000 without insurance, rendering them unaffordable for most patients.

About the study

In the present study, researchers estimated the potential decrease in annual mortality attainable by scaling the uptake of the novel obesity drugs. The US population was stratified into seven body mass index (BMI) categories, and the annual mortality was expressed as a linear combination of yearly deaths in each category using hazard ratios relative to the reference BMI (18.5 – 25 kg/m2). Annual mortality was recomputed to evaluate the impact of new weight-loss drugs by applying category-specific mortality rates to a new BMI-stratified population distribution resulting from weight loss.

Two scenarios were considered: current uptake and expanded access. The current uptake rate of drugs among eligible persons with diabetes and obesity was parameterized as 13.6% and 10.8%, respectively. In the expanded access scenario, drugs were available for all eligible persons, and the uptake rate required their ability to avail healthcare and willingness to take these medications.

In both scenarios, weight loss was contingent on drug efficacy and adherence rate. The researchers used sophisticated modeling techniques, including Monte Carlo simulations, to project shifts in BMI distribution and mortality outcomes. The number of averted deaths was estimated across US states and insurance categories.

Under the current uptake scenario, high-cost drugs would be prohibitive for the uninsured, while drug accessibility was equitable across all insurance categories under the expanded access scenario. Equal drug accessibility was assumed across all states for both scenarios. State-level prevalences of obesity, diabetes, and obesity/overweight were normalized to align with national-level estimates.

Findings

The team estimated that almost half of deaths in the US would occur in people with obesity (BMI > 30 kg/m2). Over 45% of the adult population were eligible for the weight loss drugs, comprising people with a BMI ≥ 30 kg/m2 and those with diabetes with a BMI of 25 – 30 kg/m2. By insurance status, 40% of uninsured and 54% of Medicaid recipients were eligible.

West Virginia and Mississippi had the highest per capita eligibility for these drugs. These states and Oklahoma are projected to see the largest reductions in per capita deaths. As people use these drugs, population distribution by BMI would shift towards healthier BMI ranges.

The change in population distribution by BMI was projected to be only marginal with the current uptake rate, with only 1.8% of the obese population reducing their BMI to 30 kg/m2 or lower. However, under the expanded access scenario, 10.6% of obese individuals would move to healthier BMI ranges, and 16.6% of people with severe obesity (BMI ≥ 40 kg/m2) would reduce their BMI to 40 kg/m2 or lower.

At the current uptake rate, 8,592 deaths would be reduced yearly, with 71% of these averted deaths expected among privately insured individuals, reflecting drug access inequity. This significant inequity highlights the barriers faced by uninsured and Medicaid patients, who experience higher obesity rates yet have the least access to these life-saving medications.

By contrast, 42,027 deaths could be prevented under the expanded access scenario. In addition, in this case, over 11,700 deaths could be averted among obese/overweight individuals with type 2 diabetes, with 9,997 and 2,804 deaths avertable among Medicare beneficiaries and the uninsured, respectively.

Under a more optimistic scenario, assuming greater adherence and willingness to take the drugs, up to 165,574 deaths could be prevented each year. Expanded access could lead to an annual mortality reduction of up to 15.7 deaths per 100,000 individuals, with all states expected to achieve a decrease of ≥ 9.6 deaths per 100,000 people. Oklahoma, West Virginia, and Mississippi were projected to have the largest per capita reductions.

Conclusions

The researchers estimated that if all eligible individuals had access to the new weight loss drugs, the prevalence of obesity would reduce to 38%, with more than 50,000 deaths averted every year. At the current uptake level, only 8,592 deaths were avertable yearly.

Together, expanding access to new obesity medications and prioritizing obesity as the primary condition for therapy could significantly decrease mortality rates and mitigate the economic burden. The benefits of expanded access to these drugs extend beyond mortality reduction, as it could also alleviate obesity-related comorbidities, including cardiovascular disease, diabetes, and even infections such as COVID-19.