Gastric Sleeve Cheaper, More Effective Than Semaglutide

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April 12, 2024 – Endoscopic sleeve gastroplasty (ESG), a nonsurgical weight loss procedure, is more cost-effective over a 5-year period than using semaglutide, the active ingredient in Ozempic, Wegovy, and other weight loss drugs, a study says. 

ESG reduces the size of the stomach. A suturing device is put down the throat and into the stomach, where it folds and sutures the sides of the stomach. ESG is not the same as gastric sleeve surgery, which removes a large portion of the stomach.

For the study, published Friday in JAMA Network Open, the researchers used a Markov cohort model, which measures the experiences of a hypothetical group of patients over a set period. The study took place from Sept. 1, 2022, to May 31, 2023, using adult patients in the U.S. health care system with a body mass index of 35 to 39.9. (A BMI of 30 or higher falls within the obesity range.) 

Over 1 year, ESG was not as cost-effective as semaglutide, the study said. After that, things changed.

The researchers projected that “the semaglutide strategy” would cost $33,583 more than the ESG strategy over a 5 -year period. They also projected that about 20% of people using semaglutide would stop using the drug because of medication intolerance or other causes, and would probably regain weight, the study said.

Overall, “ESG was found to be a cost-effective strategy, offering greater weight loss and cost savings. The annual cost of semaglutide would need to be reduced 3-fold, from $13,618 to $3,591, for it to be a cost-competitive alternative," the researchers wrote. 

"That’s the reality -- everybody just wants the meds but in truth the meds are expensive,” said Marina Kurian, MD, president of the
American Society for Metabolic and Bariatric Surgery, whose physician members perform the gastric sleeve and other weight loss procedures. “And if you stop them, you have significant weight regain. Patients after surgery can regain some weight, but generally not all the weight from before.”

“When you look at a cost analysis, it's not unusual to see that weight loss surgeries over two or three years have cost recoupment or
are cost neutral,” Kurian, who was not involved with the study, said. 

Drugs with semaglutide were first meant to treat type 2 diabetes, but their reputations spread when people who used the drugs also lost weight. Semaglutide is injected weekly and causes insulin release in response to high blood sugar, such as after a meal. It decreases the amount of sugar your liver makes.

Doctors say that for ESG and the semaglutide drugs to keep off weight, people need to commit to changing their diet, getting regular exercise, and doing other lifestyle changes.

“The study suggests that while semaglutide is effective for weight loss, it is not economically viable over the long term compared with ESG, which remains a cost-saving,” the researchers said.