ECRI Blog

Glucagon-like peptide receptor agonists (GLP-1 RAs) now available to promote weight loss—Wegovy (semaglutide), Zepbound (tirzepatide), and Saxenda (liraglutide)—could potentially make much needed gains against the obesity epidemic; however, the benefits of these medications come at a significant financial cost to patients and payors and the risk of rare but serious adverse events. Making sure the medications reach the right patients—those most likely to derive long-term benefits with low risk—will be critical to make the most of GLP-1 RAs. Prescribers will lead that effort by identifying and recruiting eligible patients, which is a difficult task because obesity is a complex disease; therefore, prescribing information will need to be interpreted in the context of each patient’s unique characteristics and circumstances. Furthermore, old and new misconceptions about obesity and weight loss drugs—now amplified and reinforced by social trends and media—can predispose patients and make discussions with physicians difficult.

Roughly one year after their introduction, Wegovy (semaglutide) and Zepbound (tirzepatide) continue to shake up the obesity treatment landscape in the United States. Uptake for these two glucagon-like peptide receptor agonists (GLP-1 RAs) has surpassed expectations and is driving demand for Saxenda (liraglutide), an older GLP-1 also indicated for weight loss, along with off-label use of Ozempic (semaglutide) and Mounjaro (tirzepatide), two GLP-1 formulations indicated for treating diabetes. The reason for this is clear: a large body of clinical evidence shows the drugs can help patients lose 15% to 25% additional weight when used alongside evidence-based lifestyle interventions (counseling, diet, and exercise). These effects are greater than those seen with older weight loss medications (typically ~5% total weight loss) and close to typical weight loss seen with bariatric surgery.

The prevalence of overweight and obesity keeps worsening in America despite our enormous collective effort to lose weight. The U.S. Centers for Disease Control and Prevention estimates that overweight and obesity now affect over 70% of Americans and add over $170 billion to annual U.S. healthcare costs. About half of Americans try to lose weight each year, and social trends constantly shift around a myriad of weight loss interventions and products. Among these, weight-loss-inducing medications have historically received limited attention. However, public interest and demand for weight loss drugs has spiked since the introduction of two new drugs: semaglutide (Wegovy) in 2022 and tirzepatide (Zepbound) in 2023. 

In today's healthcare environment, payers are under increasing pressure to make new and updated medical policy determinations as quickly and cost-effectively as possible.

Health technology assessments (HTAs) can provide a synthesis of the relevant evidence-based clinical literature to enable payers to make informed decisions about whether or not to cover a new medical technology. In this article, we'll explore the importance of HTAs for payers in developing strong, defensible coverage decisions.

What is a health technology assessment?

A HTA is a systematic evaluation of a technology's efficacy, safety, and cost-effectiveness. There are various HTA methods, but all HTAs share a common goal: to provide a fair and objective evaluation of a technology's benefits and risks based on the published clinical literature. This information can be used to help policymakers, clinicians, and healthcare leadersmake informed decisions about whether or not to adopt a new technology.