HEALTHCARE systems around the world are grappling with the arrival of a new kind of weight-loss treatment: injections based on the medicine semaglutide, which is branded as Wegovy or Ozempic.
The UK is among the first countries where semaglutide looks set to be made available for weight-loss treatment through a publicly funded health system. Unfortunately, many doctors think England鈥檚 guidance body has made a misstep by recommending people be restricted to two years of use, even though the drug is meant to be taken long-term. Health systems in other countries are also debating how to respond to this unprecedented situation, and none has yet found a good answer.
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The dilemma is that, for the first time, weight-loss drugs have been developed that are broadly safe and effective. But so many people need the treatment that no one can figure out how health systems will afford it. In countries such as the , US and Australia, about two-thirds of the adult population are overweight or obese.
Wegovy has so far gone on sale in only a few countries, including the US and Germany, but its launch seems imminent in the UK. And people in many countries have been using Ozempic, the version of semaglutide approved for treating type 2 diabetes, which also causes weight loss.
Policy on semaglutide in the UK is mainly up to the (NICE), the cost-effectiveness body for medicines in England, whose decisions are usually also followed in Wales and Northern Ireland. In March, NICE said people in England in certain weight and health categories could have semaglutide through the National Health Service, but . A decision in Scotland has yet to be announced.
NICE says its recommendations will provide value for money for taxpayers and are in line with the manufacturer鈥檚 evidence and the fact that UK weight-loss clinics generally only treat people for two years. The institute has said it will review its decision if longer-term evidence becomes available, but as it stands, the current position is bizarre. show that when people stop taking semaglutide, they put most of the weight they lost back on. This raises the prospect that Wegovy users will experience dramatic swings of weight loss and regain. NICE even proposed such people might then restart treatment with the drug. The consequences of such weight yo-yoing are likely to be dire.
People in other countries are similarly struggling with irrational funding policies. In the US, Medicare, the federal health insurance system for people aged 65 and older, is legally prohibited from funding weight-loss treatments. The same goes for all public insurance schemes in Germany. Some people in the US with private health insurance can access the medicine, although they may have to contribute prohibitive sums as 鈥渃opays鈥�. And as demand for Wegovy takes off, some insurers are tightening their eligibility rules, for instance by requiring that people first try cheaper, less-effective medicines.
The restrictions are irrational because weight-loss treatments will almost certainly reduce other healthcare costs, such as from joint-replacement surgery and treating heart attacks, strokes and type 2 diabetes. Those gains may take a few years to materialise, but the cost-benefit equation is likely to tip more in favour of the new weight-loss treatment as time passes. This is because drugs usually drop in price after their launch and as competitors enter the market. More potent treatments are also likely to arrive in the near future.
The advent of this new class of medicines is going to have big ramifications for healthcare systems, however they are funded. But health policy-makers must be prepared to play the long game.
Clare Wilson is a 快猫短视频 reporter and author of the Health Check newsletter
