Bariatric surgery trumps Novo Nordisk’s Wegovy in cost-effectiveness and durability

MedTech & Diagnostics News: Bariatric surgery emerges as cost-effective, boasting superior and enduring weight loss outcomes over a five-year span compared to Novo Nordisk’s Wegovy (semaglutide), as per a newly published analysis.

Obesity imposes a significant socioeconomic burden as a disease. Bariatric surgery, while highly effective, is underutilised due to concerns about invasiveness, cost, and constrained funding, particularly within Australia’s public hospital system.

In this analysis of adults with class II obesity (BMI 35-39.9), endoscopic sleeve gastroplasty (ESG) – a minimally invasive endoscopic bariatric procedure – added 0.06 more quality-adjusted life-years while costing $33,583 less than Wegovy over 5 years.

“While semaglutide is effective for weight loss, it is not economically viable over the long term compared with ESG, which remains a cost-saving alternative for this patient population. The annual price of Wegovy must decrease by more than 3-fold to achieve non-dominance with ESG,” the researchers wrote.

The widely known GLP-1 receptor agonist injectable, initially approved by the TGA in 2019 for type 2 diabetes under the brand name Ozempic, later gained approval in 2022 at an increased dosage of 2.4 mg for chronic weight management, now marketed as Wegovy. Last month, Wegovy 2.4 mg also picked up an FDA indication to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.

In this study, endoscopic sleeve gastroplasty had an incremental cost-effectiveness ratio of -$595,532 per quality adjusted life-year over a 5-year time horizon compared with Wegovy. Over 1 year, ESG was not cost-effective compared with Wegovy but when the horizon was extended to 2 years, ESG became cost-saving.

Also considered were adverse events associated with each of the two treatment strategies. With the minimally invasive, incisionless endoscopic procedure, surgical patients were assumed to have an initial quality-of-life decrement for the first week after surgery. Meanwhile, it was assumed around 20% of Wegovy patients would become non-adherent to treatment.

“The strategic choice of cost-saving yet effective treatment such as ESG compared with semaglutide for specific patient groups could help alleviate the potential budget strain expected from the use of semaglutide,” Thompson and co-authors explained.

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