Comparative Economic Value of GLP-1 Obesity Medications Vs Standard Care in Egypt

Abstract

Obesity is a major public health problem in Egypt, contributing to a high burden of type 2 diabetes (T2DM), cardiovascular disease (CVD), and related healthcare costs. GLP-1 receptor agonists (e.g., semaglutide, marketed as Ozempic/Wegovy) induce substantial weight loss (~15% of body weight) and may reduce obesity-related comorbidities, but their high cost raises questions about affordability and economic value in low-middle-income settings.
To evaluate the long-term economic impact of GLP-1 therapy for obesity versus standard care (no pharmacological intervention) in Egyptian adults with obesity from a healthcare system perspective.
A cohort Markov model was developed for obese Egyptian adults (age 40, BMI ≥30) over a 30-year horizon. Health states included no complications, T2DM, hypertension (HTN), CVD, and death. Transition probabilities were derived from Egyptian/Middle East epidemiological data and clinical trial evidence. Two strategies were compared: (a) chronic GLP-1 therapy for weight loss (with drug costs calibrated to Egyptian pricing) and (b) standard care (lifestyle management only). The model estimated the cumulative incidence of obesity-related diseases and total lifetime medical costs per person (in 2025 USD), including drug and complication treatment costs.
GLP-1 therapy markedly reduced the 30-year cumulative incidence of T2DM (approximately 20% vs 50% under standard care) and CVD events (15% vs 20%), with a moderate reduction in HTN (50% vs 70%). However, lifetime cost per person was much higher with GLP-1 therapy (~$45,000) compared to standard care (~$2,000), an incremental cost of about $43,000 driven primarily by medication expenses.
From the Egyptian healthcare perspective, GLP-1 obesity treatment can substantially improve health outcomes by preventing diabetes and CVD, but at a large financial cost. Unless drug prices fall or treatment is targeted to very high-risk groups, GLP-1 therapy is unlikely to be cost-saving in Egypt. Strategies to improve the cost-effectiveness of pharmacological obesity treatments (such as local price negotiations or selective use in those with prediabetes) are needed to justify widespread adoption in resource-limited health systems.