Semaglutides and the next public health revolution

It is hard to overstate the transformational public health benefits of anti-hypertensives and statins for blood pressure and serum cholesterol control. For a modest cost, these drugs not only mitigate human suffering but save billions, if not trillions, of dollars by avoiding costly surgical interventions.

The repurposing of anti-diabetic drugs like semaglutide and tirzepatide for weight loss in obese populations promises to be similarly transformative. I’ve witnessed this anecdotally; one of my sisters lost 90 lbs in 2.5 years on semaglutide, and for the first time in decades has a BMI in the healthy range.

“The need for the medications is undeniable. Obesity is a major contributor to preventable death in the U.S. It can lead to diabetes, heart disease, stroke, several forms of cancer, mental illness, difficulty with physical function, kidney failure, and many other maladies. It is stubbornly resistant to behavioral and dietary changes in many people.

“Obesity and its myriad consequences cost the healthcare system a quarter trillion dollars in 2020. An economic/demographic microsimulation from the USC Schaeffer Center estimates that the cumulative social benefits from solving obesity (e.g., zero obesity rate) would reach almost $1 trillion over the next 10 years, or roughly $100 billion per year. Savings to Medicare alone could be as much as $245 billion in the first 10 years of coverage.

“But the benefits and savings don’t stop there.

“Over 20 years, a period in which we can likely expect both the launch of oral GLP-1s and their eventual genericization, the prices of these medicines would likely spiral down by 80% or more and savings would compound spectacularly. Indeed, calculations based on the Schaeffer model show that the U.S. healthcare system would save $7 trillion over 30 years, on top of all the benefits due to improved quality of life and productivity.”

Anti-obesity drugs promise to bend the Medicare cost curve