By Charalampos Karouzos,
The escalating prevalence of obesity and metabolic syndrome, often referred to as the new world pandemic, has emerged as a critical public health concern, primarily affecting developed countries, with the full scale of implications in health yet to be seen. The novel weight loss drugs, most important of all Semaglutide, have emerged as a deus ex machina in the battle against obesity, being promoted by the media as the cure to obesity, and as expected have garnered significant public attention.
However, although they are among the very few options available against such a vast public health issue, the pricing of Semaglutide-based medications, such as Ozempic and Wegovy, varies considerably across different markets, raising questions about affordability and equitable access. While the debate around this topic is not new and maybe even saturated, the question set by the NYTs, “How much should weight loss drugs cost?”, sparked the conversation alive.
Currently in the world, the cost of Semaglutide-based medications varies significantly across each country, with Ozempic having a monthly cost that is approximately $93 in the United Kingdom, $87 in Australia, and $83 in France. Wegovy, another Semaglutide-based medication, is priced at about $328 in Germany and $296 in the Netherlands. These figures indicate that Semaglutide is more affordable in Europe and some countries compared to the United States, where the cost of Ozempic is estimated around $900 to $1,000 per month, depending on the pharmacy and insurance coverage.
Additionally, the entry of more drugs in the market further complicates the pricing of such drugs even more. Mounjaro, for instance, has been announced by the National Institute for Health and Care Excellence (NICE) of the UK as another option available for patients. Mounjaro combines a glucagon-like peptide-1 (GLP-1) analogue, like Semaglutide, and a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, to have the effects of both GLP-1 and GIP with an average weight reduction of nearly 23% in clinical trials. Will a more effective and probably more expensive option increase competition and decrease prices or become another solid pilar to stabilize or even increase the price of these drugs?
Diving deeper in the issue, it must be highlighted that weight loss medication, if used as intended, are effective in reducing substantially body weight, with 86% of subjects achieving a weight loss of 5% or more, and one-third experiencing a reduction of 20% or more, comparable to outcomes observed with bariatric surgery as indicated in recent studies. However, beyond its weight loss properties, Semaglutide has demonstrated significant benefits in addressing various components of the common metabolic syndrome, including hypertension, dyslipidemia, and hyperglycemia, fasting plasma glucose levels and HbA1c control. These metabolic improvements directly contribute to a decreased risk of cardiovascular events, such as myocardial infarction and stroke, two of the most common causes of overall mortality worldwide.
Although it’s difficult to fully grasp the real-world effects of these treatments, it must be said that the economic benefits of reducing healthcare expenditures associated with obesity-related complications, which can be quantified, are extraordinary. Obesity healthcare costs encompass the direct medical expenses and the indirect costs, such as lost productivity and absenteeism, without considering the second and further level effects that arise. Indeed, a report by ING Bank indicated that the healthcare costs and productivity losses associated with obesity significantly exceed the costs of new weight-loss drugs, such as Ozempic and Wegovy, suggesting a clear economic benefit of these medications in countries like the UK, Germany, and the Netherlands. By reducing the prevalence of obesity and associated comorbidities, Semaglutide-based medications can decrease healthcare utilization and improve workforce productivity.
Even though data indicate that these novel drugs can have far more reaching potential than achieving an unrealistic and clandestine super skinny silhouette; the issue of affordability remains a central concern. Their cost creates barriers to widespread access, with insurance coverage playing a crucial role in determining access and hindering equity. In countries with nationalized healthcare, such as France and the UK, government subsidies can help offset costs, providing in a regulated manner access to those that need them. However, in more privatized healthcare systems, including that of the United States, out-of-pocket expenses for patients can be prohibitive; while the proposal of regulating drug pricing to ensure affordability runs contrary to the idea of the free market, even if the “market” in this case is human life.
To illustrate the potential financial implications of widespread Semaglutide adoption, consider a hypothetical scenario in a developed European country with a population of 50 million, where 30% (15 million individuals) have obesity. Assuming an annual cost of $1,200 per patient for medication (based on the UK’s price of approximately $100 per month), the total expenditure would amount to $18 billion per year. Although allocating $18 billion annually to obesity treatment would represent a significant investment, considering the potential healthcare savings from reduced obesity-related diseases and improved productivity, this could be offset over time. Moreover, investing in health, particularly in preventive and treatment strategies for chronic conditions, can enhance life expectancy, workforce efficiency, and economic stability, reducing other related budgetary expenditures.
Although from this analysis, investing in weight loss drugs may appear as a straightforward option in achieving significant societal benefits, in reality, these medications are heavily intertwined with ethical dilemmas. Firstly, these drugs, although not inherently useless for managing certain health conditions, enter a landscape dominated by unrealistic beauty standards that equate thinness with worth and health. Moreover, obesity into a large extend can be prevented through lifestyle choices and the promotion of such drugs, risks oversimplifying the issue, offering an easy solution to a problem created by modern life itself. We live in an environment where processed foods, sedentary habits, and relentless advertising of unattainable body ideals have shaped our attitudes toward health.
By focusing on medication as a quick fix, we are bypassing the need to address these deeper, systemic issues. The ethical dilemma lies in how these drugs are marketed and sponsored; does their promotion support a real solution exclusively to health problems, or does it reinforce harmful societal pressures that prioritize appearance over genuine well-being? Shifting to a macroscopic lense one can argue that rather than challenging the environments and behaviors that contribute to obesity, these medications can perpetuate a culture that favors quick, surface-level fixes instead of fostering lasting, sustainable change. Are we even acknowledging the full complexity of the problem, or are we just offering a quick, marketable answer to a much deeper societal issue?
Going back to the original question that reignited the conversation, how much should these drugs cost? It’s a question that, on a deeper level, can be misleading, as the price itself is not simply an economic issue to be answered by Adam Smith’s supply and demand theory. If made to an affordable price, access will increase, but will a lower price increase equity of access? Regulating their availability appears as the only solution not only to increase health equity but to prevent opening this pandora’s box. Drugs can and will be misused, but that doesn’t give society the fertile ground to allow the already growing ethical concerns to be watered and blossom.
References
- Semaglutide: a price and HTA comparison between US and top European markets. Pharmaceutical Technology. Available here
- Semaglutide: a game changer for metabolic diseases? Exploration of Medicine. Available here
- How do prices of drugs for weight loss in the U.S. compare to peer nations? Peterson-KFF Health System Tracker. Available here
- Effects of Semaglutide on Metabolic Syndrome Parameters in Non-Diabetics: A Meta-analysis of Randomized Controlled Trials. Metabolism. Available here
- The Price of Ozempic, Wegovy Can Be 400% Higher in the U.S. Healthline. Available here
- Semaglutide Effects on Metabolic Outcomes in Diabetes Mellitus: A Real-World Evidence Study. Frontiers in Endocrinology. Available here
- Health and productivity losses from obesity ‘far outstrip weight-loss jab costs’. The Guardian. Available here
- Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. The New England Journal of Medicine. Available here
- Sixty seconds on… the cost of semaglutide. The BMJ. Available here
- Ozempic is 1,300% more expensive in the U.S. vs the U.K.—so the CEO is heading to Washington. Yahoo Finance. Available here
- Denmark gets Novo Nordisk to lower Ozempic prices. Fortune. Available here
