How one company wants to bring a value-based care approach to obesity treatment

Injectable drugs developed to treat Type 2 diabetes have become increasingly popular as weight loss solutions. But a new study suggests that GLP-1 medications may not be the most cost-effective treatment for every patient.

A team of researchers compared the costs of pricey GLP-1 prescriptions to expenses associated with long-term obesity-related health conditions, and found that only certain patients with a body mass index (BMI) over 40—or class 3 obesity—saw economic value in using those medications.

Rajesh Aggarwal, a longtime bariatric surgeon who worked on the study that was published in June, told Healthcare Brew that the findings suggest GLP-1s may not be worth the price for most patients or insurers. Instead, he said, the healthcare industry should take a more value-based care approach to obesity.

“This needs to be about the reduction of total cost of care,” said Aggarwal, the founder and CEO of Twenty30 Health, a tech company for people with obesity. “Just saying, ‘Hey, everyone with a BMI over 30 should go on a GLP-1,’ doesn’t make sense. But it also doesn’t make sense saying, ‘Everyone with a BMI over 35 should have bariatric surgery,’ right? It’s about doing that cost-value analysis.”

The findings

Obesity and related conditions are estimated to cost the world $4 trillion by 2035—or almost 3% of the global gross domestic product. Researchers, who examined whether GLP-1 drugs that can lead to significant weight loss pay for themselves, found relatively low healthcare cost increases among users without comorbidities, diabetes, or behavioral conditions, as well as those with a BMI between 30 and 40. However, those costs “escalate significantly” for patients with a BMI of 40+, according to the study.

With healthcare costs averaging about $10,800 for one diabetes patient with a BMI of 45, researchers found that reducing that person’s weight by 15%–20%—the published weight reduction range for GLP-1 users (or 7–9 BMI points)—would lower annual healthcare costs for that patient by $2,000 to $2,500. Meanwhile, weight loss for a patient with higher healthcare costs due to conditions like renal disease could reduce the individual’s healthcare spending by up to $10,000 annually.

“Offsetting the limited reduction in healthcare costs is the significant increase in costs” to insurers or other payers due to the price of GLP-1 prescriptions, which can run up to $14,000 each year before rebates or discounts, the study noted.

Researchers found that if an employer got a 50% reduction in the drug’s price with rebates or discounts, a GLP-1 would be cost-effective for a patient with renal disease, but not for a person with a comorbid condition like diabetes. They concluded that “there is no economic case for a payer to reimburse the cost of the drug at the current price point, except in rare cases of very high BMI or certain comorbidities.”

Aggarwal said the study did not look at the costs associated with using GLP-1s beyond one year or medication adherence, and it assumed that patients saw typical weight loss—even though some patients in clinical trials saw no weight loss while using the drug. Further, the risk of weight regain after stopping GLP-1 use could further undermine the potential economic value of such drugs, the study noted.

“I’m not trying to be the anti-GLP-1 lobby at all. I’m trying to say, ‘How do we integrate this?’ How do we risk-stratify the population?” he said. “We need to go beyond [total weight loss] in terms of remission of disease—not just diabetes, hypertension, but also mental illness, depression, anxiety. And how is that then apportioned in terms of reduction in total cost of care?”

Twenty30 Health

Aggarwal wants to revolutionize obesity care so it’s more focused on value—similar to how other chronic conditions, like cancer, are treated. He founded Twenty30 Health in early 2023 to offer a technology-driven, comprehensive, and cost-efficient approach to obesity treatment.

“Why isn’t there value-based care around obesity? Obesity doesn’t exist as a specialty right now; it’s hard to kind of corral different pieces from a patient perspective and then also from a health system or a provider perspective,” he said.

To fix that, Twenty30 is developing an “end-to-end” multimodal care model that aims to integrate behavioral health, nutrition, exercise, medication, and surgical therapies via an app and technology platform, as well as through health coaches.

Aggarwal said the company will initially focus on how to better serve, engage, educate, and empower patients who are already in their bariatric surgery journeys before adding on services addressing medication, nutrition, behavioral health, and exercise.

Twenty30’s technology platform is set to go live soon with a couple of health systems and will be made available to patients—and eventually to employees via the systems’ employee health plans, Aggarwal said.

“The approach here is rather than this costs x, this costs y, this costs z. […] Who do we risk-stratify? What journey do we put them on? What outcomes are they [having]? And how does that reduce the total cost of care?” he said.