Cost-Effectiveness of Pharmacologic Treatments in Adults With Overweight or Obesity: A Systematic Review for the American College of Physicians.
This systematic review, conducted for the American College of Physicians, evaluated the cost-effectiveness of pharmacologic treatments for overweight or obesity in U.S. adults. Researchers searched MEDLINE, Embase, and economic databases through October 2025, ultimately including 9 studies encompassing 42 pairwise treatment comparisons. Study quality was assessed using the CHEQUE tool, value was measured via incremental cost-effectiveness ratios (ICERs) against established willingness-to-pay thresholds, and certainty of evidence was graded using GRADE. Key findings from the 6 moderate-certainty studies suggested that liraglutide had low value compared with lifestyle modification, while phentermine-topiramate and tirzepatide showed high value versus lifestyle modification. Semaglutide demonstrated low value compared with naltrexone-bupropion and phentermine-topiramate, but high value compared with liraglutide. Important limitations include that all 9 included studies were model-based rather than empirical trial-based analyses, only 4 of 9 were at low risk of bias, none of the 42 comparisons reached high certainty, and reporting was frequently incomplete. The authors conclude that current U.S. evidence on cost-effectiveness of obesity pharmacotherapy is significantly hampered by poor study quality, restricting the strength of any conclusions that can be drawn.
Why this grade: This is a systematic review and economic synthesis rather than a primary clinical study; it synthesizes only model-based cost-effectiveness analyses, none of which reached high GRADE certainty, limiting direct translation to human clinical evidence.
A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. To evaluate cost-effectiveness of pharmacologic treatments in adults with overweight or obesity in a U.S. setting. MEDLINE, Embase, and economic databases, searched on 13 October 2025. Non-industry-sponsored U.S. trial-based and model-based cost-effectiveness evaluations of pharmacologic treatments in adults with overweight or obesity. Data on clinical characteristics, economic characteristics (for example, model type), and study outcomes were extracted by one reviewer and verified by a second reviewer. Study quality was assessed using the CHEQUE (Criteria for Health Economic Quality Evaluation) tool; value was assessed using incremental cost-effectiveness ratios (ICERs), with thresholds for high value ( $200 000 per QALY), and no value (strict or extended dominance, or less costly and less effective); and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Four out of 9 included studies were at low risk of bias. None of the 42 pairwise comparisons that were reported had high certainty. In the 6 studies with moderate certainty, liraglutide had low value and phentermine-topiramate and tirzepatide had high value when each was compared with lifestyle modification. Semaglutide had low value compared with naltrexone-bupropion and phentermine-topiramate and high value compared with liraglutide. All studies were model-based. ICERs were not reported for all potential treatment comparisons. Most studies had incomplete reporting or were at high risk of bias. Current evidence on cost-effectiveness of pharmacologic treatment of overweight or obesity is hampered by poor-quality studies, limiting the ability to draw conclusions. American College of Physicians. (PROSPERO: CRD42023491646).
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