REAL-WORLD EFFECTIVENESS OF ANTI-OBESITY PHARMACOTHERAPY IN MEDICARE: INTEGRATED 100% FEE-FOR-SERVICE CLAIMS AND EMR ANALYSIS OF BMI REDUCTION AND CARDIOVASCULAR OUTCOMES
Author(s)
Onur Baser, MA, MS, PhD1, Yijia Sun, MS2, Nehir Yapar, BS2, Yuanqing Lu, MS2, Shuangrui Chen, MS2.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA.
1City University of New York (CUNY), New York, NY, USA, 2Columbia Data Analytics, New York, NY, USA.
OBJECTIVES: Modern anti‑obesity pharmacotherapy vs non‑pharmacologic management among 100% CMS Medicare Fee‑for‑Service (FFS) beneficiaries with obesity was evaluated, focusing on BMI change and cardiovascular (CV) risk markers/tests using claims linked with laboratory results and EMR.
METHODS: Columbia Data Analytics’ Medicare-Enhanced Lab & Demographics (MELDTM) dataset was used to conduct retrospective analysis of beneficiaries with obesity (baseline BMI≥30kg/m²) 2021-2024. Claims were deterministically linked to laboratory results and EMR (serial BMI, CV-related tests). Among several million beneficiaries, 420,000 had continuous enrollment and ≥2 BMI and CV measurements. Of these, 125,000 initiated anti‑obesity medication (treatment group); 295,000 received lifestyle counseling without medication (non‑treatment group). Two-year outcomes: BMI change; systolic/diastolic BP; LDL/HDL cholesterol; triglycerides; HbA1c; new abnormal stress tests, left ventricular ejection fraction (LVEF) change, incident MACE. Inverse probability of treatment weighting and multivariable regression adjusted for demographics, baseline BMI, comorbidities, prior CV disease.
RESULTS: Baseline mean (SD) BMI=37.2kg/m² (5.1) (treatment), 36.9kg/m² (5.3) (non‑treatment); 68% female, 72% had hypertension, 64% dyslipidemia, and 48% diabetes. Two-year adjusted mean BMI decreased 6.2kg/m² (treatment; 16.3% mean weight loss) vs 1.4kg/m² (4.1% weight loss) (non‑treatment; between‑group difference −4.8kg/m², p<0.001). Mean systolic BP declined 8.1mmHg vs 3.0mmHg, respectively (difference −5.1mmHg, p<0.001), diastolic BP by 3.1 vs 1.0mmHg (difference −2.1mmHg, p<0.01). LDL cholesterol decreased 19.5% vs 6.8%, respectively; HDL increased 5.2% vs 1.6%; triglycerides declined 21.3% vs 7.4% (all p<0.001). Among beneficiaries with diabetes, mean HbA1c declined 0.9 percentage points vs 0.3, respectively (p<0.001). New abnormal stress tests=7.8% vs 11.9%, respectively (adjusted risk ratio [ARR]=0.68, 95%CI=0.64-0.73), and worsening LVEF (≥50% to <50%) in 5.4% vs 8.7% (ARR=0.62, 95%CI=0.57-0.68). Over median 2.1 years, adjusted HR of MACE=0.78 (treatment; 95%CI=0.72-0.84) vs non‑treatment.
CONCLUSIONS: Anti‑obesity pharmacotherapy showed roughly four‑fold greater BMI reduction, 5-6mmHg greater systolic BP reduction, improved lipid/glycemic profiles, fewer abnormal CV test findings, and 22% lower MACE risk vs non‑treatment.
METHODS: Columbia Data Analytics’ Medicare-Enhanced Lab & Demographics (MELDTM) dataset was used to conduct retrospective analysis of beneficiaries with obesity (baseline BMI≥30kg/m²) 2021-2024. Claims were deterministically linked to laboratory results and EMR (serial BMI, CV-related tests). Among several million beneficiaries, 420,000 had continuous enrollment and ≥2 BMI and CV measurements. Of these, 125,000 initiated anti‑obesity medication (treatment group); 295,000 received lifestyle counseling without medication (non‑treatment group). Two-year outcomes: BMI change; systolic/diastolic BP; LDL/HDL cholesterol; triglycerides; HbA1c; new abnormal stress tests, left ventricular ejection fraction (LVEF) change, incident MACE. Inverse probability of treatment weighting and multivariable regression adjusted for demographics, baseline BMI, comorbidities, prior CV disease.
RESULTS: Baseline mean (SD) BMI=37.2kg/m² (5.1) (treatment), 36.9kg/m² (5.3) (non‑treatment); 68% female, 72% had hypertension, 64% dyslipidemia, and 48% diabetes. Two-year adjusted mean BMI decreased 6.2kg/m² (treatment; 16.3% mean weight loss) vs 1.4kg/m² (4.1% weight loss) (non‑treatment; between‑group difference −4.8kg/m², p<0.001). Mean systolic BP declined 8.1mmHg vs 3.0mmHg, respectively (difference −5.1mmHg, p<0.001), diastolic BP by 3.1 vs 1.0mmHg (difference −2.1mmHg, p<0.01). LDL cholesterol decreased 19.5% vs 6.8%, respectively; HDL increased 5.2% vs 1.6%; triglycerides declined 21.3% vs 7.4% (all p<0.001). Among beneficiaries with diabetes, mean HbA1c declined 0.9 percentage points vs 0.3, respectively (p<0.001). New abnormal stress tests=7.8% vs 11.9%, respectively (adjusted risk ratio [ARR]=0.68, 95%CI=0.64-0.73), and worsening LVEF (≥50% to <50%) in 5.4% vs 8.7% (ARR=0.62, 95%CI=0.57-0.68). Over median 2.1 years, adjusted HR of MACE=0.78 (treatment; 95%CI=0.72-0.84) vs non‑treatment.
CONCLUSIONS: Anti‑obesity pharmacotherapy showed roughly four‑fold greater BMI reduction, 5-6mmHg greater systolic BP reduction, improved lipid/glycemic profiles, fewer abnormal CV test findings, and 22% lower MACE risk vs non‑treatment.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P5
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)