News Review
18 JULY 2025 ausdoc. com. au
ALAMY
Wes Streeting, UK Secretary of State for Health and Social Care.
How do you make GLP-1 RAs worth other people’ s money?
THERE are many wondrous things about GLP-1 receptor agonists, not least their capacity to cripple national health budgets.
Given the scale of obesity and its economic cost, governments around the globe have been wrestling with whether to fund the treatments through a variety of cost-benefit formulations.
It has been said that they mark a pivotal moment in addressing one of the world’ s most pressing health crises.
And that is the problem. Put simply, with so many patients likely to benefit, how do you ensure equity based on patient need without costs sinking the ship?
Or do you have to throw equity based on patient need out the window and go for a harder-edged argument from the“ dismal” science, say one rooted in the patient’ s future economic utility?
Mohana Basu( left) Senior reporter Paul Smith( right) Editor
The drugs are sold as a fix to the obesity epidemic but at a cost.
What the PBAC thinks
As we know, the PBAC has already baulked at the price tag of semaglutide.
Two years ago, it rejected an application by Novo Nordisk to list Wegovy on the PBS for adults with an initial BMI of 40kg / m 2 or above and at least two diagnosed weight-related conditions.
The drug maker said at least one of these related conditions needed to be obstructive sleep apnoea, osteoarthritis of the knee or prediabetes.
The PBAC threw it out, saying there was“ no strong clinical rationale for the obesity comorbidities selected” and that Novo Nordisk failed to identify patients“ most likely to experience relatively large reductions in weight or long-term benefits from weight loss”.
The decision was in sharp contrast to the one made in the UK.
Since 2023, its government has been funding semaglutide for people with at least one weight-related comorbidity and a BMI of 30kg / m 2 or above.
Late last year, it followed up, announcing that tirzepatide( Mounjaro) would be free for adults with at least one weightrelated condition and a BMI of 35kg / m 2 or above.
As you would expect, it came as big news.
UK Health Secretary Wes Streeting said it would reduce sick days as a result of obesity, as well as help those with overweight get back to work.
He later had to backtrack slightly on
Can we ensure equity based on patient need without costs sinking the ship?
these economic benefits, declaring he was“ not interested in some dystopian future where I involuntarily jab unemployed people who are overweight”.
But why the contrast between here and the UK? Is the PBAC being tight-fisted?
Are British pockets deeper?
There is no hard-and-fast threshold, but the PBAC is likely to consider a drug worth funding if it costs less than $ 50,000 for every quality-adjusted life year( QALY) it delivers: the equivalent of one additional year of life in perfect health.
In the case of GLP-1 receptor agonists( RAs) for obesity, the UK’ s PBAC equivalent— the National Institute for Health and Care Excellence( NICE)— had calculated a gain of 0.7 QALYs per patient receiving semaglutide in those with a BMI of 30kg / m 2 or more.
However, the PBAC in its November 2023 decision reported a gain of just 0.3 QALYs, and this was in a population with a BMI of 40kg / m 2 and above, in which you would expect the benefits to be greater.
Both the NICE and PBAC analyses focused on the results of the SELECT trial, which enrolled 17,500 patients aged 45 or older with pre-existing cardiovascular disease and a BMI of 27kg / m 2 or greater but no history of diabetes.
The PBAC said it noted the“ top-line positive results” from the SELECT trial, which were announced by Novo Nordisk via a press release, particularly the part that indicated semaglutide treatment was associated with a 20 % relative risk reduction in major cardiovascular events compared with placebo in patients with overweight / obesity and established cardiovascular disease.
However, the PBAC said it could not