Health Care Costs and Use of Patients Prescribed Four Different Obesity Medications

OBJECTIVE: This study compared changes in health care costs and use across cohorts initiating four obesity medications (OMs). METHODS: Commercial insurance claims were used to identify new initiators of phentermine (n = 136,788), phentermine-topiramate-ER (n = 13,888), naltrexone-bupropion-SR (n = 28,712), or liraglutide (n = 49,266) for obesity. Multivariable difference-in-differences analyses compared the three newer drugs to phentermine for change in total annual prescription drug and health care costs, outpatient visits, and acute care use (combined emergency department visits and hospital stays). RESULTS: Up to 3 years after OM initiation, prescription and total health care costs were higher for all three newer OM cohorts relative to phentermine, with liraglutide having the greatest comparative increase in annual costs (e.g., total costs 73.6% [70.9%, 76.3%] higher in year 1). Primary care physician visit frequency was slightly lower for the newer OMs (e.g., -12.6% [-13.6%, -11.6%] in year 1 for liraglutide). CONCLUSIONS: The cost of OM treatment, even for medications that preceded highly effective weekly incretin analogues, appeared to increase overall prescription spending and total health care costs. Yet, other than a relative decrease in primary care physician visit frequency, more costly OMs were not associated with favorable changes in health care use patterns compared to generic phentermine. Reductions in OM cost and other interventions to support their longer-term use may be needed to fully realize the promise of these medications.