REAL WORLD INSIGHTS INTO OBESITY CARE: UNDERSTANDING TREATMENT PATTERNS AND PAYER COSTS AT AN INTEGRATED HEALTH SYSTEM
Author(s)
Apoorva M. Pradhan, MPH, BAMS (MD)1, Eric Wright, MPH, PharmD2, Jonathan Brady, PharmD1, Seth Gazes, MS1, Adam Kelchner, MBA1, Joseph Chronowski, MBA1, Kate Saylor, PhD3;
1Geisinger Health, Danville, PA, USA, 2Geisinger Health System, Forty Fort, PA, USA, 3Geisinger College of Health Sciences, Danville, PA, USA
1Geisinger Health, Danville, PA, USA, 2Geisinger Health System, Forty Fort, PA, USA, 3Geisinger College of Health Sciences, Danville, PA, USA
OBJECTIVES: Obesity affects more than 40% of U.S adults and is associated with healthcare costs of more than $173 billion annually. Despite their effectiveness, anti-obesity medication (AOM) costs remain a limiting factor in their utilization. Understanding patient characteristics and health system resource utilization is a foundational step towards developing relevant economic models to identify populations with the highest potential for benefit.
METHODS: Geisinger-insured adult patients with a diagnosis of obesity or a BMI of > 27 kg/m2 treated at Geisinger between May 2019 and September 2024 were identified using electronic health records and claims data. Patients on an AOM, categorized by pharmacy class (e.g., GLP1, phentermine, others), were compared to control patients who were followed by Nutrition and Weight Management but not initiated on any AOM. We computed descriptive statistics for clinical and demographic characteristics. Using a payor perspective, we computed the total per member per month (pmpm) medical (restricted to inpatient and emergency department admissions) and pharmacy costs for the subset of patients with 12 months of follow-up data, using the plan-paid amounts, and compared them between the intervention and control populations.
RESULTS: We identified 14,857 eligible patients. Of these patients, 68% were prescribed an AOM, most of whom received a GLP-1 agonist (78.1%). More than 40% of patients in both the AOM and the control arm had class III obesity at baseline. Twelve-month follow-up claims data were available for 6549 (44%) of eligible patients. Compared to control patients, the total pharmacy pmpm costs for AOM patients were more than 2.5 times higher ($838.94 vs. $318.9), while the total medical pmpm costs were 12% lower ($560.24 vs. $635.84).
CONCLUSIONS: More than two-thirds of obese patients received medication-based therapy for managing obesity and related complications, resulting in higher pharmacy pmpm costs, which are marginally offset by lower medical pmpm costs.
METHODS: Geisinger-insured adult patients with a diagnosis of obesity or a BMI of > 27 kg/m2 treated at Geisinger between May 2019 and September 2024 were identified using electronic health records and claims data. Patients on an AOM, categorized by pharmacy class (e.g., GLP1, phentermine, others), were compared to control patients who were followed by Nutrition and Weight Management but not initiated on any AOM. We computed descriptive statistics for clinical and demographic characteristics. Using a payor perspective, we computed the total per member per month (pmpm) medical (restricted to inpatient and emergency department admissions) and pharmacy costs for the subset of patients with 12 months of follow-up data, using the plan-paid amounts, and compared them between the intervention and control populations.
RESULTS: We identified 14,857 eligible patients. Of these patients, 68% were prescribed an AOM, most of whom received a GLP-1 agonist (78.1%). More than 40% of patients in both the AOM and the control arm had class III obesity at baseline. Twelve-month follow-up claims data were available for 6549 (44%) of eligible patients. Compared to control patients, the total pharmacy pmpm costs for AOM patients were more than 2.5 times higher ($838.94 vs. $318.9), while the total medical pmpm costs were 12% lower ($560.24 vs. $635.84).
CONCLUSIONS: More than two-thirds of obese patients received medication-based therapy for managing obesity and related complications, resulting in higher pharmacy pmpm costs, which are marginally offset by lower medical pmpm costs.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD77
Topic
Real World Data & Information Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)