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We know they are expensive, but isn’t the cost recouped by the healthcare savings? Dr F. Perry Wilson explains. https://www.medscape.com/viewarticle/glp-1s-are-crazy-effective-just-not-cost-effective-2025a10006es?src=soc_yt --TRANSCRIPT-- Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr F. Perry Wilson from the Yale School of Medicine. Much of my time in these videos is spent talking about whether a drug or supplement or diet or intervention works or not. That’s the central focus of medical science: Can we do something for a patient and make a difference in their health? But there’s a related question that we rarely discuss that is almost equally as important: Is this drug or supplement or diet or intervention worth it? And I don’t mean “worth it” in some meta-physical sense. I mean "worth it" in terms of dollars and cents. Is the cost we pay for something worth the benefit we derive from it? I’ll make the argument that the most effective drugs in the past decade are the GLP-1 receptor agonists, drugs like semaglutide and tirzepatide. At least in terms of weight loss, they are truly unparalleled. They are clearly effective. But are they worth it? Are they cost-effective? That is a much harder question, and, as you’ll see in a minute, despite their amazing effects, the answer — for now, at least — is no. How do we decide if a drug is cost-effective? What does that even mean? I’ll give you some extreme examples to illustrate the point a bit. First, for it even to be possible that a drug is cost-effective, it must be effective. It must improve health in some clear, measurable way. Pink jelly beans, while quite inexpensive, do not improve health at all and are therefore not cost-effective. Policymakers should not advocate that insurers cover pink jelly beans. On the flip side are drugs and interventions that actually make money for the system — things that are so good for you, they save money in the long term. The childhood vaccination program is probably the best example of this. The CDC estimates that for every $1 spent on the program, the payer saves about $3 in future costs and society saves about $10 in future costs. This is why insurers have no problem covering childhood vaccines; they would literally be leaving money on the table if they didn’t. So those are the extremes. Don’t pay for pink jelly beans, do pay for vaccines. But we don’t think it is appropriate to cover only stuff that saves money. We are willing to trade money for longer life or quality of life. And this is where the rubber meets the road when it comes to cost-effectiveness analysis: How much is your life worth? To an economist, the answer is basically $100,000 per year of perfect health. The ways they arrive at this number are pretty fascinating, but a lot of it is done by looking at what we as a society are willing to pay for. A cost of $100,000 per “quality-adjusted life year” (QALY) is our standard candle here. More than that is not particularly cost-effective. Less than that is. The “quality” in the QALY is important too. Economists know that a year of perfect health is worth more, in dollar terms, than a year of moderate or poor health. So, if we take an intervention and do some clever modeling based on the price of the intervention and its effectiveness at improving health, we can tell you how much it costs per QALY. Here are a few examples. We have an intervention to pay people to quit smoking. This costs about $2500 per QALY. Seems pretty good. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/glp-1s-are-crazy-effective-just-not-cost-effective-2025a10006es?src=soc_yt

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