Healthcare Expenses Increase After GLP-1 Prescription

Real-world patients prescribed the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy; Novo Nordisk) do lose weight and see an improvement in cardiovascular risk factors, but a new analysis suggests that, even with these benefits, their health expenditures appear to increase in the short term.

Total monthly expenditures, not including the cost of the drug, increased by $80 per patient in the combined population of those with and without diabetes, with inpatient costs accounting for approximately half that amount.

The data, from two large US health systems, highlight a “disconnect” between the clinical benefits and short-term costs of the newer weight-loss medications, the authors say in the paper published in JAMA Network Open. How cost-effectiveness might change with continued use of GLP-1s isn’t yet known.

“It’s not a substantial amount of increase, but it’s statistically significant,” said Yuan Lu, ScD (Yale School of Medicine, New Haven, CT), the study’s lead author. “I think these kinds of results that we’re seeing just raise the caution that the uptake of semaglutide or tirzepatide does not immediately translate into a short-term reduction in medical cost.”

While the study can’t definitively identify what the extra spending is or if it’s consistent across all patients eligible for a GLP-1, Lu said the findings suggest that “after starting the medication, the health system is experiencing more hospital visits for heart- and metabolic-related conditions, and that is the major driver for the expenditure going up.”

It could be that some patients have CV risk factors and are starting on the medication for those reasons anyway, and then subsequently have events or undergo workups for related conditions, she said.  

“There may be more frequent health and weight follow-up visits,” Lu added, as well as insurance-mandated visits for dose adjustments and other things related to the medication itself.

Money Spent a Variety of Ways

The analysis includes 23,522 adults (mean age 56.2 years; 66.7% female; 68.6% with diabetes) who received a prescription for semaglutide between January 2018 and January 2025 at Sentara Healthcare in Virginia or Yale New Haven Health in Connecticut.

The mean reduction in body weight for the cohort at 13 to 24 months was 3.8% of their baseline weight. Patients without diabetes lost approximately 5% of their starting weight. Diastolic BP decreased by a mean of 1.5 mm Hg, with a corresponding systolic BP decrease of 1.1 mm Hg. Total cholesterol decreased by 12.8 mg/dL, while hemoglobin A1c was reduced by 0.3% in diabetic patients and by 0.1% in those without diabetes.

The healthcare expenditures per patient were slightly higher in the group without diabetes than in those with diabetes, at $81 versus $67 per month, respectively.

“Most diagnostic categories showed increasing expenditures, suggesting broad increases in healthcare use, especially for endocrine and cardiovascular conditions,” Lu and colleagues note.

A sensitivity analysis that incorporated individual fixed effects was confirmatory of the main results.

While the weight loss and the CV benefits seen in the study are similar to what was seen in patients in trials like STEP 1 and SURMOUNT-1, they’re not as large. Specifically, in the non-diabetic population, STEP 1 participants lost nearly 15% of their starting weight by 12 months—in these data, patients lost 5.1%.

To TCTMD, Lu said one of the things that an analysis like this can’t measure is the impact of drug discontinuation on expenditures, but there is a suggestion that real-world patients may not have taken the medication as long as those in the trials, as evidenced by the cohort’s mean exposure duration being only 6 to 7 months.

Why patients discontinue the drug early is not entirely clear, but during the timeline the investigators looked at, semaglutide was in shortage. Then there are issues of insurance, with some big pharmacy benefit managers in the US like CVS Caremark recently announcing plans to stop covering tirzepatide on some of the plans they manage. In other cases, monthly co-pays, which can be quite variable, may become too much of a financial burden for some patients, Lu noted.

It’s also possible healthcare expenses could rise for someone recently prescribed a GLP-1 but who either couldn’t afford it anymore, or stopped taking it for other reasons, because the medication actually was controlling their CV risk factor.

“It would be a very important to look at in the future, especially the [consistency] of taking the medication and the impact on their clinical and healthcare expenses down the road,” Lu added.