Cost Offsets and Spending on Glucagon-like peptide-1 receptor agonists (GLP-1s) in a Large National Electronic Health Record Database

About This Grant

Abstract Obesity and overweight impose significant clinical and economic burdens, impacting over 64% of U.S. adults, leading to healthcare costs exceeding $170 billion annually. This project focuses on glucagon-like peptide-1 receptor agonists (GLP-1s), first approved for weight loss in 2021, a promising treatment for obesity that not only induces substantial weight loss but also improves metabolic conditions such as cardiovascular disease and diabetes. Despite their effectiveness, the high cost of GLP-1s, over $7,000 per year, has resulted in limited insurance coverage, thereby restricting patients' ability to access these potentially transformational medicines. The central objective of this research is to determine if GLP-1 therapy can offset their high costs by reducing overall healthcare spending for patients who initiate treatment. Clinical trials show the clinical benefits of GLP- 1s but have limitations, including no established link between weight loss with GLP-1s and healthcare spending and short follow-up periods that make it difficult to assess long-term outcomes. By leveraging a large national dataset, Truveta, which contains Electronic Health Records for over 100 million patients, linked with insurance claims, the study aims to provide much-needed long-term evidence on spending. We will leverage state-of-the-art matching, and real-world evidence methods to achieve three key aims: (1) evaluating long-term cost offsets and medication costs after GLP-1 initiation, (2) assessing how these costs vary across patient subgroups defined by characteristics like BMI, age, and comorbidities, and (3) estimating the GLP-1 breakeven price and the time required to achieve budget neutrality. These findings will inform insurers and policymakers, contributing to future coverage and reimbursement decisions, with significant implications for Medicare, Medicaid, and private insurers. The project directly responds to calls from the Congressional Budget Office and other key stakeholders for more research on the economic impact of GLP-1 therapies.