Presentation (CTI)

OBJECTIVES: Distributional cost-effectiveness analysis (DCEA) methods were developed to help decision makers consider trade-offs between maximising population health and reducing inequalities. Obesity is a chronic disease associated with substantial morbidity, complications, mortality, and socioeconomic deprivation. Obesity medications, in conjunction with diet and exercise (D&E), offer novel solutions to the growing obesity epidemic. However, the equity impacts of these treatments are unknown. This study examined the equity impacts of obesity medications in England based on different uptake assumptions, to inform decision-making on their implementation.
METHODS: An aggregate DCEA was conducted to estimate the impact of semaglutide 2.4mg on health inequalities in England, using Index of Multiple Deprivation (IMD) quintiles as the stratifying socioeconomic variable. Incremental costs and quality-adjusted life years (QALYs) were sourced from the Core Obesity Model and combined with the size and distribution of the population to calculate net health benefits for each IMD quintile. Health Survey for England and Clinical Practice Research Datalink (CPRD) were used to source obesity prevalence and medication uptake data. Changes in health inequality and net health benefit were adjusted using inequality measures and health-related social welfare indices.
RESULTS: Using a cost-effectiveness threshold of £20,000 or 30,000 per QALY, semaglutide 2.4 mg compared to D&E resulted in a positive mean net benefit in the base case, and an improvement in equity outcomes. Equity impacts were highly sensitive to uptake of the intervention and prevalence of obesity. As uptake in the two most deprived quintiles increases, the equity impacts become increasingly positive.
CONCLUSIONS: This aggregate DCEA found that semaglutide 2.4mg is cost-effective, improves total population health and reduces health inequalities. Equity impacts were driven by obesity prevalence and medication uptake rates. This means targeted implementation plans will play an important role in maximising total health benefit and reducing inequalities for obesity medications.