OBJECTIVES: Obesity is a multifaceted disease with implications for multiple organ systems and significant health and economic burdens. However, interpreting the value of weight loss treatment is complicated by reliance on complex decision-analytic models. This study aims to elucidate the value drivers of obesity treatment and identify potential gaps in existing economic analyses.
METHODS: A targeted review of economic models of obesity treatment was conducted to summarize key features for each model. Insights from these studies and further literature review were used to identify high-prevalence and high-cost complications that may be substantially reduced by weight loss. Outcomes incorporated in health technology assessment submission models were compared with identified value drivers to summarize rationales used for inclusions/exclusions.
RESULTS: Review of three health technology assessment submission models and six published models (including one from Institute for Clinical and Economic Review) revealed that cost savings from weight loss primarily arise from delayed or avoided onsets of chronic complications such as type 2 diabetes mellitus (T2DM), cardiovascular diseases, and liver diseases. Among over 25 reported obesity-related complications, a subset including eating disorders, sleep apnea, T2DM, metabolic-associated fatty liver disease or metabolic-associated steatohepatitis (MASH), osteoarthritis of the knee, and cardiovascular diseases exhibited the highest and most statistically significant association with weight loss. Complications reported with the highest healthcare costs in patients with obesity were T2DM ($16,728-$17,286/year, 2023 publications), MASH ($16,744-$22,953/year, 2020-2023 publications), and heart failure ($3,586-$25,102/year, 2021 and 2023 publications). Baseline weight and diabetes diagnoses were key clinical characteristics influencing weight loss benefits.
CONCLUSION: Previous economic models of weight loss interventions may have undercounted the benefits of weight loss by excluding prevalent obesity-related complications with high costs such as MASH and sleep apnea. Additional analytic, time-bound, population-based tools are warranted to allow payers to make informed, value-based coverage decisions.
