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Case Reports
. 2024 Apr 1;7(4):e246221.
doi: 10.1001/jamanetworkopen.2024.6221.

Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss

Muhammad Haseeb  1   2 , Jagpreet Chhatwal  3 , Jade Xiao  4 , Pichamol Jirapinyo  1 , Christopher C Thompson  1
Affiliations
Case Reports

Semaglutide vs Endoscopic Sleeve Gastroplasty for Weight Loss

Muhammad Haseeb et al. JAMA Netw Open. .

Abstract

Importance: Obesity is a disease with a large socioeconomic burden. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric procedure with wide global adoption. More recently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (eg, semaglutide), have attracted increased attention due to their efficacy. However, their cost-effectiveness over an extended period compared with ESG is a critical gap that needs to be better explored for informed health care decision-making.

Objective: To assess the cost-effectiveness of semaglutide compared with ESG over 5 years for individuals with class II obesity.

Design, setting, and participants: This economic evaluation study, conducted from September 1, 2022, to May 31, 2023, used a Markov cohort model to compare ESG and semaglutide, with a no-treatment baseline strategy. 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.

Interventions: Strategies included treatment with semaglutide and ESG.

Main outcomes and measures: Costs (2022 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) with a willingness-to-pay threshold of $100 000/QALY. A 5-year time horizon with a cycle length of 1 month with a 3% discount rate was used. Probabilities, costs, and quality-of-life estimates of the model were derived from published literature. One-way, 2-way, and probabilistic sensitivity analyses were also performed.

Results: The model found that ESG was more cost-effective than semaglutide over a 5-year time horizon, with an ICER of -$595 532/QALY. Endoscopic sleeve gastroplasty added 0.06 QALYs and reduced total cost by $33 583 relative to semaglutide. The results remained robust on 1-way and probabilistic sensitivity analyses. Endoscopic sleeve gastroplasty sustained greater weight loss over 5 years vs semaglutide (BMI of 31.7 vs 33.0). To achieve nondominance, the annual price of semaglutide, currently $13 618, would need to be $3591.

Conclusions and relevance: This study suggests that ESG is cost saving compared with semaglutide in the treatment of class II obesity. On price threshold analyses, a 3-fold decrease in the price of semaglutide is needed to achieve nondominance.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chhatwal reported receiving personal fees from Value Analytics Labs outside the submitted work. Dr Jirapinyo reported receiving personal fees from Apollo Endosurgery, GI Dynamics, ERBE, and Spatz; grants from Boston Scientific, Fractyl, and USGI Medical; and royalty payments from Endosim for endoscopic training simulator outside the submitted work. Dr Thompson reported receiving grants and personal fees from Apollo Endosurgery, Boston Scientific, Endoquest Robotics, Fractyl, Fujifilm, GI Dynamics, Lumendi, Olympus, and USGI Medical; receiving personal fees from Medtronic, Softac, and Xenter; receiving grants from ERBE; being a founder and board member of and having an ownership interest in Bariendo; being a founder and general partner of BlueFlame Healthcare; being a founder and board member of and having an ownership interest in ELLES; being a founder and board member of and having an ownership interest in Enterasense; being a founder and board member of and having an ownership interest in EnVision Endoscopy; being a founder and board member of and having an ownership interest in GI Windows; having an ownership interest in Fractyl; being a founder and president of and having an ownership interest in the Society for Metabolic and Bariatric Endoscopy; having an ownership interest in Softac; and serving on the scientific advisory board for and having an ownership interest in Xenter outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Results of 1-Way Sensitivity Analyses Performed Over a 5-Year Time Horizon
One-way sensitivity analysis involves adjusting the value of 1 model parameter at a time to assess the association with study outcomes. This figure includes the 10 parameters with the largest association with incremental cost-effectiveness ratio (ICER) values when modified. The numbers on either side of the bars indicate the extreme parameter values associated with the resulting ICER shown in the figure. This figure is centered around the base case with an ICER of –$595 532 per quality-adjusted life-year. ESG indicates endoscopic sleeve gastroplasty; EV, expected value.
Figure 2.
Figure 2.. Cost-Threshold Analysis of Semaglutide Compared With Incremental Cost-Effectiveness Ratio (ICER) of Endoscopic Sleeve Gastroplasty Over 5-Year Time Horizon, With Willingness-to-Pay (WTP) Threshold of $100 000 per Quality-Adjusted Life-Year (QALY)
The cost threshold at which semaglutide can be nondominant to endoscopic sleeve gastroplasty at the 5-year time horizon is $3591.
See this image and copyright information in PMC

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