New research suggests that anti-obesity drugs can be produced and sold at much lower prices around the world than their current high costs. The study calls for a public health approach to managing obesity, prioritizing access to drugs over drug company profits.
Cost variation can improve affordability and access to care.
New research shows that several anti-obesity drugs could be produced and sold worldwide at much lower estimated prices than their high costs, according to a new study in ObesityThe Obesity Societys (TOS) main journal.
Access to medicine is a fundamental element of the human right to health. As the obesity pandemic grows, especially among low-income communities, effective medical care remains unaffordable for millions in need. Our study highlights the price inequality that exists for effective anti-obesity drugs, which are largely unaffordable in most countries. However, we show that these drugs can indeed be profitably produced and sold at low prices. A public health approach that prioritizes improving access to medicines should be adopted, rather than allowing companies to maximize profits, said Jacob Levi, Intensive Care Medicine, Royal Free Hospital NHS Trust, London, UK. Levi is the study’s corresponding author.
Experts explain that growing recognition that diet and exercise alone are unlikely to lead to sustained weight loss has led to renewed interest in drugs to complement lifestyle changes. Randomized controlled trials have demonstrated positive results with oral and injectable drugs. However, these drugs remain prohibitively expensive in most countries. Such high prices make it difficult for millions of people to afford drugs and gain access to treatment.
It would be great if everyone had affordable access to all medicines that could improve their health. Yet this is simply not possible, nor will it ever be. What is really needed is a better way to ration currently available health care dollars in efforts to maximize population health. This is the challenge not only for anti-obesity drugs, but for all treatments, said Eric A. Finkelstein, professor, Duke-NUS Medical School, Singapore, in a commentary on the study.
On the other hand, the authors called for a public health-based approach to managing obesity similar to that used with other diseases. Andrew Hill, Department of Pharmacology and Therapeutics, University of Liverpool, UK, supervising author of the study, commented: “Worldwide, more people die from diabetes and clinical obesity than from HIV, tuberculosis and malaria combined. Together. Millions of lives have been saved by treating infectious diseases at low cost in poor countries. Now we have to repeat this medical success story, with mass treatment of diabetes and clinical obesity at low prices. Pharmaceutical companies have an ethical responsibility to make their new treatments for diabetes and obesity available to anyone who needs them, in any country.
The study authors searched national drug price databases and collected information on six drugs: orlistat, naltrexone/bupropion, topiramate/phentermine, liraglutide, semaglutide and tirzepatide in a range of 16 low-, middle-, and high-income countries. In each country, the researchers evaluated multiple online national price databases and selected the lowest available price from each of the sources. The selected drugs have been chosen because they have proven to be effective and because they illustrate a range of different monotherapies, combination tablets and injectable treatments.
Estimated Minimum Prices (EMPs) for anti-obesity drugs were calculated using an established methodology using active pharmaceutical ingredients from the Panjiva database. EMPs were calculated per 30-day course and include costs for active pharmaceutical ingredients, excipients, formulation, tax, and 10% profit margin.
The results revealed that national prices of oral and injectable anti-obesity drugs were significantly higher than the calculated EMPs.
Oral medications:
- Orlistat: Prices for a 30-day course of treatment were over $100 in the US and under $1 in Vietnam. EMP calculated from Export API data was approximately $7 per 30-day course.
- Naltrexone/bupropion: Costs for combined naltrexone/bupropion tablets range from $326 in the US to $56 in South Africa compared to an EMP of $55 per 30-day course.
- Topiramate/phentermine: Price data was only available in the United States as the drug is not licensed for use for weight loss in several countries due to safety concerns. Prices in the US ranged from $120 to $199 per course compared to the combined tablet EMP at $5. Prices were also researched separately for topiramate and phentermine and combined with data available together from the US, South Africa, and Kenya. EMPs for each drug individually were $0.86 for topiramate and $0.53 for phentermine (total of $1.39 per course) based on API export data.
Injectable drugs:
- Liraglutide: The injectable antidiabetic and weight-loss agent liraglutide costs $1,418 in the United States and $252 in Norway. The EMP per 30-day course was $50. The researchers note that this price was calculated assuming the most efficient concentration and dosage of pens available for injection.
- Semaglutide: National price data for subcutaneous semaglutide all exceeded EMPs, ranging from $804 in the United States to $95 in Turkey. The EMP of subcutaneous semaglutide was calculated to be approximately $40 per 30-day course.
- Tyrzepatide: National pricing data was available only in the United States, where the drug was recently cleared for use in type 2 diabetes by the Food and Drug Administration. The drug is not only licensed for obesity. Prices for the 30-day course ranged from approximately $715.56 to $1,100.70. There was not enough data in the database to calculate an EMP.
The study authors note that EMPs are intended as realistic targets for competitive generic manufacturing rather than proprietary releases.
Caroline M. Apovian, MD, FTOS, co-director of the Center for Weight Management and Wellness and professor of medicine at Harvard Medical School in Boston, Mass., commented: Once shown that anti-obesity agents, particularly GLP-1 and their combinations result in a lower cardiovascular risk, so we can claim universal insurance coverage from these agents. These agents used for obesity before the advent of type 2 diabetes,[{” attribute=””>cardiovascular disease and other complications, have the power to reduce the cardiovascular burden and lower mortality worldwide. Apovian was not associated with the research.
The study, titled Estimated Minimum Prices and Lowest Available National Prices for Anti-obesity Medications: Improving Affordability and Access to Treatment, is online and was published in the May 2023 print issue of Obesity.
Reference: Estimated minimum prices and lowest available national prices for antiobesity medications: Improving affordability and access to treatment by Jacob Levi, Junzheng Wang, Francois Venter and Andrew Hill, 23 February 2023, Obesity.
DOI: 10.1002/oby.23725
Other authors of the study include Junzheng Wang, Medical Sciences Office, Oxford University, Clinical Academic Graduate School, University of Oxford, Oxford, United Kingdom and Francois Venter, Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Venter has received support from the Bill and Melinda Gates Foundation, U.S. Agency for International Development, Uni-taid, SA Medical Research Council, Foundation for Innovative New Diagnostics, the Childrens Investment Fund Foundation, Gilead, ViiV, Mylan, Merck, Adcock-Ingram, Aspen, Abbott, Roche, Johnson & Johnson, Sanofi, Virology Education, SA HIV Clinicians Society and Dira Sengwe. The other authors declared no conflict of interest.
Funding for this study was provided by the Make Medicines Affordable/International Treatment Preparedness Coalition, grant number ITPC-MV_2020, and National Heart, Lung, and Blood Institute of the National Institutes of Health under award number UG3HL156388.
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