The Institute for Clinical and Economic Review (ICER), a nonprofit health technology assessment organization based in the United States, recently evaluated the cost-effectiveness of lifetime use of semaglutide and three other antiobesity-medication regimens (brand-name liraglutide, phentermine–topiramate, and bupropion–naltrexone; including generic versions of phentermine and topiramate, and bupropion and naltrexone) for a 45-year-old patient as compared with lifestyle modification alone. ICER’s evaluation concluded that semaglutide wasn’t cost-effective, with an estimated cost of $237,000 per quality-adjusted life-year gained.2 This estimate reflects both changes in life expectancy and quality of life associated with improved daily functioning and a reduced risk of diabetes and cardiovascular outcomes; however, it is well above the $100,000-to-$150,000 range considered the upper bound for cost-effectiveness in the United States.2 Under current U.S. thresholds, the annual $13,618 price of semaglutide would need to decrease to $7,500 to $9,700 for the drug to be cost-effective as compared with lifestyle modification alone.2 In that price range, however, it still wouldn’t be cost-effective as compared with generic phentermine and topiramate.2 Even with such discounted prices, the budgetary effects for Medicare could be substantial.
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