The Real-World Costs of GLP-1 Receptor Agonist Treatment

Background The high cost and widespread use of glucagon-like peptide 1 receptor agonists (GLP-1RAs) are a concern for healthcare budgets. Whether GLP-1RA use reduces other health care spending is unclear.

We conducted a cohort study using insurance claims data for United States adults aged 18-64 from 2016-2024, matching GLP-1RA treated members with untreated members (controls) on baseline demographics, clinical conditions, hospitalization, and medication use. Primary outcomes were per member per month (PMPM) healthcare costs overall and by service type, analyzed separately for members with and without diabetes.

Among 742,824 matched treated and control members, 55.6% had diabetes. In year 1 following GLP-1RA initiation, total costs were 68.7% higher in treated members (95% CI, 68.0%-69.4%, $743 PMPM difference); in years 2-6 costs were 44.8% higher (95% CI, 43.7%-45.9%; $530 PMPM difference). Excluding GLP-1RA costs, treated members had 5.8% higher costs in year 1 (95% CI 5.1%-6.5%) and 4.1% higher costs (95% CI 3.0% - 5.2%) in years 2-6. Among treated members with diabetes, cost increases were modest: 3.8% (95% CI 2.8% - 4.8%) in year 1 and 0.8% in years 2-6 (95% CI 0.6%-2.2%), with non-GLP-1RA pharmacy and provider visits offset by reduced admissions and dialysis. Treated members without diabetes had more substantial cost increases: 8.9% in year 1 (95% CI 7.7% - 10.1%) and 9.7% in years 2-6 (95% CI 8.0% - 11.4%).

GLP-1RA treatment was associated with increases in spending on healthcare net of the GLP-1RA cost, particularly in members without diabetes. Question What are the real-world costs of GLP-1 receptor agonist (GLP-1RA) treatment for adults with diabetes and other conditions? Findings GLP-1RAs treatment is associated with substantially increased healthcare costs. Excluding the costs of GLP-1RAs, treated adults with diabetes have modest increases in costs; however, those treated without diabetes have costs that are.9% higher than those not receiving the drug. Meaning Medical costs of using GLP-1RAs for those without diabetes go far beyond the costs of the agents. An estimated 40% of the US adult population are eligible for treatment for obesity. Treating them with GLP-1RAs would have a substantial impact on insurance costs. Competing Interest Statement No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Dr. Mugiishi serves as Board member and Chair, Clinical Advisory Subcommittee of the Board, Blue Cross Blue Shield Association. Dr. Hashmi reported receiving stocks and options from Elevance Health. Drs. Skinner and Wennberg serve as consultants to Blue Health Intelligence. Dr. Skinner serves as the Program Director at the National Bureau of Economic Research, which includes an IPA contract with the NIH. Dr. Skinner also reports equity ownership in Dorsata, Inc. No disclosures for other authors. Funding Statement This study was funded by the Blue Cross Blue Shield Association. The funder had a role in the collection of the data. The funder had no role in the management of the data, conduct or design of the study, analysis, or interpretation of the data. The funder had no role in the preparation of the manuscript. The funder had a role in the review and approval of the manuscript. The authors jointly agreed to submit the manuscript for publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This retrospective cohort study was exempted from full review by the Sterling Institutional Review Board (Protocol #12167) and granted a waiver of informed consent. This study used the National Data Warehouse, managed by Blue Cross Blue Shield Association, housing BCBS Plan submitted data (e.g., medical claims, membership data). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Individual participant data will not be made available, in compliance with the data use agreement with the Blue Cross Blue Shield Association.