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Real-World GLP Costs, Rocket Off Hold, and TAVR Deterioration
August 25, 2025
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Together with
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“Medicine is the only field in America where people pay massive tuition and lose 15 years of earning potential just for the privilege of practicing. By the time they’re called ‘young’ or ‘early career,’ many are in their 40s.
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Jason Locasale, PhD
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Real-world semaglutide (Wegovy) patients might be experiencing a healthcare cost paradox, after a recent analysis in JAMA showed that GLP-1s successfully reduce weight and improve cardiovascular risk factors, but lead to increased patient healthcare expenditures in the short term.
- Semaglutide is a GLP-1 receptor agonist approved for weight management and CV risk reduction, with established cardiovascular benefits in clinical trials like STEP 1.
- The drug has shown dramatic trial results, but real-world cost-effectiveness data has been limited until now.
The real-world analysis examined 23.5k adults prescribed semaglutide between January 2018 and January 2025 across two large U.S. health systems and found over a 13-24 month follow-up that…
- Patients achieved meaningful clinical benefits including 3.8% average weight reduction, 1.5 mmHg diastolic BP decrease, and 12.8 mg/dL total cholesterol reduction.
- However, total monthly healthcare expenditures (excluding drug costs) increased by $80 per patient, with inpatient costs driving approximately half the increase.
- The cost increase was consistent across diabetic ($67/month) and non-diabetic ($81/month) populations.
Even with proven clinical efficacy, the findings reveal a disconnect between immediate clinical benefits and short-term healthcare economics, raising questions about how long GLP-1s take to become cost-effective.
- The increase suggests more hospital visits for cardiometabolic conditions may be driving higher expenditures after medication initiation.
- Real-world weight loss (5% in non-diabetics) was also less dramatic than trial results (nearly 15% in STEP 1), likely due to shorter treatment duration (6-7 months on average).
Given the complexity of real-world GLP-1 use, multiple factors may be influencing the cost-effectiveness equation beyond the medication’s direct clinical effects.
- Drug shortages, coverage changes, and co-pays may contribute to discontinuation patterns that affect long-term cost outcomes.
- Additional healthcare utilization may also come from insurance-mandated follow-up visits, dose adjustments, and increased monitoring.
- The analysis also couldn’t measure how early discontinuation impacts expenditures.
The Takeaway
For a while people have said, “GLP1s are expensive, but they will pay for themselves by reducing downstream healthcare costs.” They probably meant fewer heart attacks and delayed/avoiding chronic diseases (diabetes, HF, etc) and those things might still be true in the long run, but this study does not support that theory within months 13-24.
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