Presentation (CTI)

OBJECTIVES: National Institute for Health and Care Excellence (NICE) recommendations have expanded access to pharmacological treatments for obesity in England. This study evaluated real-world uptake of NICE-recommended obesity medicines and compared observed utilisation with forecasts.
METHODS: A descriptive analysis of NHS Innovation Scorecard data was undertaken. Quarterly utilisation data for obesity medicines were extracted from the first available reporting period through to the most recent quarter. Forecast uptake estimates were obtained from NICE resource impact reports. Projected patient numbers were converted into estimated annual treatment exposure, expressed as assumed daily doses (ADDs), by multiplying the number of patients by assumed treatment duration in patient-days based on weekly dosing schedules. ADDs were standardised per 100,000 population using mid-year England population estimates. Observed utilisation was compared descriptively with forecast estimates.
RESULTS: Between Q2 2022/23 and Q1 2024/25, utilisation data were available for liraglutide and semaglutide. Total utilisation increased across primary and secondary care settings. In secondary care, ADDs per 100,000 population rose from 66.97 to 278.52, while primary care utilisation increased from 97.50 to 207.85. Liraglutide accounted for all utilisation prior to 2023/24 and remained predominant immediately following semaglutide introduction. However, semaglutide uptake increased rapidly, surpassing liraglutide by Q4 2023/24 and accounting for 76.5% of secondary care and 93.6% of primary care utilisation by Q1 2024/25. Forecast data was available only for semaglutide. NICE projections estimated expected utilisation of 1,217 ADDs per 100,000 population in 2023/24, compared with observed utilisation of 296 ADDs per 100,000.
CONCLUSIONS: The gap between forecast and use indicates slower-than-expected uptake of semaglutide, probably because of real-world constraints such as specialist prescribing and limited service capacity. This suggests that NICE resource impact estimates may overstate early costs due to assumed real-world access being slower than what is achieved in practice.