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Endoscopic sleeve gastroplasty more cost-effective than with semaglutide

An economic evaluation comparing endoscopic sleeve gastroplasty (ESG) with semaglutide for treating class II obesity has suggested ESG is cost saving compared with semaglutide and the price threshold analyses revealed that a three-fold decrease in the price of semaglutide is needed to achieve non-dominance. The findings are primarily due to the increased effectiveness and lower costs of ESG and the increased dropout rates over time with semaglutide, according to US researchers.

The study authors from Brigham and Women’s Hospital, Massachusetts General Hospital, Boston, MA, the University of Pittsburgh Medical Center, Pittsburgh, PA and the Georgia Institute of Technology, Atlanta, GA, assessed the cost-effectiveness of semaglutide compared with ESG over five years for individuals with class II obesity, using a Markov cohort model.

The study comprised adult patients in the US health care system with class II obesity (body mass index [BMI] of 35-39.9). The base case was a 45-year-old patient with class II obesity (BMI of 37). Patients undergoing ESG were subjected to risks of perioperative mortality and adverse events with resultant costs and decrement in quality of life.

The primary outcomes were costs (2022 US dollars), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of US$100,000/QALY. The probabilities, costs and quality-of-life estimates of the model were derived from published literature. One-way, two-way and probabilistic sensitivity analyses were also performed.

The first-year clinical data were derived from two randomised clinical trials STEP 1 and MERIT. Furthermore, the data for the years two to five were derived from published studies and publicly available data sources.


The authors found that in the base-case analysis, the QALYs accumulated over five years were 3.55 for no treatment, 3.60 for semaglutide and 3.66 for ESG . The semaglutide strategy cost $33,583 more than the ESG strategy over this time horizon. Endoscopic sleeve gastroplasty was cost saving, with lower cost and higher QALYs. They also reported that due to medication intolerance or other causes, approximately 20% of modelled patients dropped out of the semaglutide strategy. Endoscopic sleeve gastroplasty achieved and sustained greater weight loss compared with semaglutide over a five-year time horizon for the modeled patients (BMI of 31.7 vs 33.0).

However, over the one-year time period, ESG was not cost-effective compared with semaglutide, with an ICER of $240 265/QALY (2), but when the time horizon was extended to years years, ESG became cost saving and dominated the semaglutide strategy.

The sensitivity analyses projected over five-years, with ESG remaining cost saving in all analyses, with an ICER of –$595 532 per QALY for the base case. For one years, the cost required for the ESG procedure to become cost-effective compared with semaglutide with an ICER threshold of $100 000/QALY - currently $16,360 - was $11,098. The annual price of semaglutide to achieve non-dominance compared with ESG with an ICER threshold of $100 000/QALY over a 5fiveyear time horizon was $,3591 and is currently at $13,618.

“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,” the authors noted. “…A strength of our analyses lies in using first-year data from these randomised clinical trials with the following years’ data from published literature to assess the cost-effectiveness of the two strategies over a five-year time horizon. This provides a reasonable time frame for comprehensively assessing the cost-effectiveness of the two strategies, which has important implications for patients, health care professionals and policymakers for medical decision-making at individual and population levels.

The findings were featured in the paper, ‘Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss’, published in JAMA Network Open. To access this paper, please click here


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