Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment

Levi, Jacob; Wang, Junzheng; Venter, François; Hill, Andrew

doi:10.1002/oby.23725

Cited by 25 publications

(20 citation statements)

References 36 publications

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“…Our findings have implications for clinical and reimbursement decision-making. Several recent studies have argued that the large number of individuals eligible for antiobesity treatment in the US implies that coverage for expensive drugs such as GLP-1 agonists will significantly strain payers’ budgets . Our findings suggest that, as a weight-loss treatment for adolescents, the relatively low-cost phentermine-topiramate will both place smaller demands on health care budgets and offer better value for money.…”

Section: Discussionmentioning

confidence: 67%

“…Despite the enormous public interest in and the potential downstream health benefits associated with these drugs, concerns regarding economic value and treatment access remain. While prices of orlistat and phentermine-topiramate range from around $1500 to $8500 per year, other drugs—such as semaglutide and liraglutide—cost more than $12 000 per year, which is well above the minimum prices for these drugs to be profitable with a 10% profit margin . Furthermore, even as clinical trials indicate that these drugs are effective, the efficacy varies considerably across drugs, with a 2 to 17 percentage point reduction in body mass index (BMI) after 1 year relative to placebo .…”

Section: Introductionmentioning

confidence: 99%

“…While prices of orlistat and phentermine-topiramate range from around $1500 to $8500 per year, other drugs-such as semaglutide and liraglutide-cost more than $12 000 per year, 11 which is well above the minimum prices for these drugs to be profitable with a 10% profit margin. 12 Furthermore, even as clinical trials indicate that these drugs are effective, the efficacy varies considerably across drugs, with a 2 to 17 percentage point reduction in body mass index (BMI) after 1 year relative to placebo. [13][14][15][16] Their long-term efficacy and the prospect of weight regain after patients stop treatment are also unknown.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Mital,

Nguyen

2023

JAMA Netw Open

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ImportanceAlthough the American Academy of Pediatrics has recommended treatment with antiobesity drugs for adolescents, the cost-effectiveness of antiobesity drugs for this population is still unknown.ObjectiveTo quantify cost-effectiveness of different antiobesity drugs available for pediatric use.Design, Setting, and ParticipantsThis economic evaluation used a Markov microsimulation model with health states defined by obesity levels. Effectiveness was measured by quality-adjusted life-years (QALYs) and costs were calculated from third-party payer perspective, estimated in 2023 US dollars over a 10-year horizon. Data were obtained from the published literature.InterventionAntiobesity drugs orlistat, liraglutide, semaglutide, and phentermine-topiramate vs no treatment. Metformin hydrochloride and 2 types of bariatric surgical procedures (sleeve gastrectomy and gastric bypass) were considered in sensitivity analysis.Main Outcomes and MeasuresIncremental cost-effectiveness ratio.ResultsAmong the 4 antiobesity drugs currently approved for pediatric use, phentermine-topiramate was the most cost-effective with an incremental cost-effectiveness ratio of $93 620 per QALY relative to no treatment in this simulated cohort of 10 000 adolescents aged 12 to 17 years (mode, 15 years) with severe obesity (62% female). While semaglutide offered more QALYs than phentermine-topiramate, its higher cost resulted in an incremental cost-effectiveness ratio ($1 079 480/QALY) that exceeded the commonly used willingness-to-pay threshold of $100 000 to $150 000/QALY. Orlistat and liraglutide cost more and were less effective than phentermine-topiramate and semaglutide, respectively. Sleeve gastrectomy and gastric bypass were more effective than phentermine-topiramate but were also more costly, rendering them not cost-effective compared with phentermine-topiramate at the willingness-to-pay threshold of $100 000 to $150 000/QALY.Conclusions and RelevanceIn this economic evaluation of weight loss drugs for adolescents with severe obesity, we found phentermine-topiramate to be a cost-effective treatment at a willingness-to-pay threshold of $100 000 to $150 000/QALY. Further research is needed to determine long-term drug efficacy and how long adolescents continue treatment.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Mital,

Nguyen

2023

JAMA Netw Open

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“…Improving affordability and access to treatment" [1]. The authors show that current antiobesity medication (AOM) prices are well above estimated minimum prices (EMP).…”

mentioning

confidence: 99%

“…There is a counterargument to this line of thinking, which is alluded to in the manuscript [1]. The argument is that, because of the high costs of obesity, greater access to these medicines would be both health improving and cost saving.…”

mentioning

confidence: 99%

Can we have our cake and eat it too? Not when it comes to antiobesity medication prices

Finkelstein

Chay

2023

Obesity

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We read with interest the article titled "Estimated minimum prices and lowest available national prices for antiobesity medications:Improving affordability and access to treatment" [1]. The authors show that current antiobesity medication (AOM) prices are well above estimated minimum prices (EMP). This is no surprise. Nonprofit firms tend to set prices equal to EMP and expand output so they can serve as many people as possible without losing money. Pharmaceutical companies, being for-profit, tend to restrict output so they can sustain a higher price that maximizes profits. This is possible because these firms have enough market power to sustain a high price without having to worry about being undercut by competitors. This market power is not by accident. It primarily comes in the form of patent protection afforded by governments for a defined period before competition is allowed. When patents expire, prices generally fall toward EMP as competition increases. In the meantime, how should governments work to "lower prices and improve access to effective AOMs to help fight the growing obesity pandemic"?The most direct route taken by many governments to lower out-of-pocket costs is through direct subsidies. These subsidies

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Estimated Sustainable Cost-Based Prices for Diabetes Medicines

Barber,

Gotham,

Bygrave

et al. 2024

JAMA Netw Open

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ImportanceThe burden of diabetes is growing worldwide. The costs associated with diabetes put substantial pressure on patients and health budgets, especially in low- and middle-income countries. The prices of diabetes medicines are a key determinant for access, yet little is known about the association between manufacturing costs and current market prices.ObjectivesTo estimate the cost of manufacturing insulins, sodium-glucose cotransporter 2 inhibitors (SGLT2Is), and glucagonlike peptide 1 agonists (GLP1As), derive sustainable cost-based prices (CBPs), and compare these with current market prices.Design, Setting, and ParticipantsIn this economic evaluation, the cost of manufacturing insulins, SGLT2Is, and GLP1As was modeled. Active pharmaceutical ingredient cost per unit (weighted least-squares regression model using data from a commercial database of trade shipments, data from January 1, 2016, to March 31, 2023) was combined with costs of formulation and other operating expenses, plus a profit margin with an allowance for tax, to estimate CBPs. Cost-based prices were compared with current prices in 13 countries, collected in January 2023 from public databases. Countries were selected to provide representation of different income levels and geographic regions based on the availability of public databases.Main Outcomes and MeasuresEstimated CBPs; lowest current market prices (2023 US dollars).ResultsIn this economic evaluation of manufacturing costs, estimated CBPs for treatment with insulin in a reusable pen device could be as low as $96 (human insulin) or $111 (insulin analogues) per year for a basal-bolus regimen, $61 per year using twice-daily injections of mixed human insulin, and $50 (human insulin) or $72 (insulin analogues) per year for a once-daily basal insulin injection (for type 2 diabetes), including the cost of injection devices and needles. Cost-based prices ranged from $1.30 to $3.45 per month for SGLT2Is (except canagliflozin: $25.00-$46.79) and from $0.75 to $72.49 per month for GLP1As. These CBPs were substantially lower than current prices in the 13 countries surveyed.Conclusions and RelevanceHigh prices limit access to newer diabetes medicines in many countries. The findings of this study suggest that robust generic and biosimilar competition could reduce prices to more affordable levels and enable expansion of diabetes treatment globally.

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Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment

Cited by 25 publications

References 36 publications

Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Cost-Effectiveness of Antiobesity Drugs for Adolescents With Severe Obesity

Can we have our cake and eat it too? Not when it comes to antiobesity medication prices

Estimated Sustainable Cost-Based Prices for Diabetes Medicines

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