The Conventional Cost‐Effectiveness and Distributional Cost‐Effectiveness of Semaglutide for Obesity Treatment
- 1Department of Health Management and Policy University of Michigan School of Public Health Ann Arbor Michigan USA
- 2Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston Massachusetts USA
- 3Department of Health Policy and Management Harvard T.H. Chan School of Public Health Boston Massachusetts USA
Abstract
Objective: This study aimed to evaluate the conventional and distributional cost‐effectiveness of semaglutide, laparoscopic sleeve gastrectomy (LSG), and a “do nothing” option in Black and White racial subgroups.
Methods: A Markov simulation model was developed from a healthcare perspective over a 25‐year time horizon for Black and White adults, aged 65–70, with BMI ≥ 35 and cardiovascular disease. Three interventions were modeled: semaglutide 2.4 mg, LSG, and “do nothing.”
Results: Semaglutide and LSG interventions are cost‐effective compared to a “do nothing” strategy (ICERs = $7300/QALY and $12,100/QALY, respectively). Compared to semaglutide, LSG is more expensive but cost‐effective (ICER = $53,700/QALY). Semaglutide is more equitable but is not distributionally cost‐effective compared to LSG, because it has a lower EDE within our defined inequality aversion (ε) range. Across 10,000 probabilistic iterations, LSG has a 57% probability and semaglutide has a 43% probability of being the most cost‐effective at the willingness‐to‐pay threshold of $100,000/QALY. Semaglutide becomes distributionally cost‐effective when ε ≥ 14.72, where equity impacts of semaglutide outweigh the conventional cost‐effectiveness outcomes.
Conclusions: LSG is the most conventionally cost‐effective treatment option with some uncertainty. Semaglutide is marginally more equitable than LSG but is not a distributionally cost‐effective strategy.
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BibTeX
@article{kulkarni2026conventional,
title = {{The Conventional Cost‐Effectiveness and Distributional Cost‐Effectiveness of Semaglutide for Obesity Treatment}},
author = {Neeti S. Kulkarni and David Hutton and Corwin Rhyan and Jeffrey S. McCullough and Michaela Greenlee and Ankur Pandya},
journal = {Obesity (Silver Spring, Md.)},
year = {2026},
month = oct,
doi = {10.1002/oby.70311},
url = {https://doi.org/10.1002/oby.70311},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Conventional Cost‐Effectiveness and Distributional Cost‐Effectiveness of Semaglutide for Obesity Treatment
AU - Neeti S. Kulkarni
AU - David Hutton
AU - Corwin Rhyan
AU - Jeffrey S. McCullough
AU - Michaela Greenlee
AU - Ankur Pandya
PY - 2026
DA - 2026/10/07
JO - Obesity (Silver Spring, Md.)
DO - 10.1002/oby.70311
UR - https://doi.org/10.1002/oby.70311
AB - Objective: This study aimed to evaluate the conventional and distributional cost‐effectiveness of semaglutide, laparoscopic sleeve gastrectomy (LSG), and a “do nothing” option in Black and White racial subgroups. Methods: A Markov simulation model was developed from a healthcare perspective over a 25‐year time horizon for Black and White adults, aged 65–70, with BMI ≥ 35 and cardiovascular disease. Three interventions were modeled: semaglutide 2.4 mg, LSG, and “do nothing.” Results: Semaglutide and LSG interventions are cost‐effective compared to a “do nothing” strategy (ICERs = $7300/QALY and $12,100/QALY, respectively). Compared to semaglutide, LSG is more expensive but cost‐effective (ICER = $53,700/QALY). Semaglutide is more equitable but is not distributionally cost‐effective compared to LSG, because it has a lower EDE within our defined inequality aversion (ε) range. Across 10,000 probabilistic iterations, LSG has a 57% probability and semaglutide has a 43% probability of being the most cost‐effective at the willingness‐to‐pay threshold of $100,000/QALY. Semaglutide becomes distributionally cost‐effective when ε ≥ 14.72, where equity impacts of semaglutide outweigh the conventional cost‐effectiveness outcomes. Conclusions: LSG is the most conventionally cost‐effective treatment option with some uncertainty. Semaglutide is marginally more equitable than LSG but is not a distributionally cost‐effective strategy.
SN - 1930-7381
SN - 1930-739X
ER -