Presentation (CTI)

OBJECTIVES: GLP-1 receptor agonists (GLP-1RAs) have demonstrated weight loss and glycemic control benefits at the population level. However, questions remain regarding their cost-effectiveness and generalizability across diverse patient populations with varying comorbidity profiles. This study sought to determine which subpopulations benefit most from GLP-1RA therapy both clinically and economically, and whether lower-cost alternatives are preferable in certain groups.
METHODS: We analyzed a dataset of 66 million patients from electronic health records and claims data. Patients were stratified by demographics, comorbidities, lab, and vital data. High-dimensional propensity score matching was applied to compare GLP-1RA users with non-users. Endpoints included changes in BMI, hemoglobin A1c, need for surgeries, critical care, and health care utilization (e.g., visits, imaging, emergency/inpatient use, and total drug expenditures excluding GLP-1RAs).
RESULTS: Overall, many subpopulations exhibited significant improvements in BMI and hemoglobin A1c, along with reduced surgical and critical care requirements. Health care utilization also declined, particularly in emergency and inpatient settings, leading to lower total costs in these groups. However, certain populations with specific comorbidity profiles (ie patients with mild to moderate kidney damage, patients with peripheral artery disease) did not derive comparable benefit and were better managed with lower-cost therapeutic alternatives.
CONCLUSIONS: GLP-1RAs can offer important clinical advantages and cost savings for numerous patients, but these benefits are not uniform. Stratified treatment decisions considering comorbidities can identify individuals most likely to achieve both clinical improvements and cost reductions, thereby guiding more efficient and precision care.