A new report from the Reinsurance Group of America (RGA) quantifies the mortality and morbidity impacts of anti-obesity medications, noting that these will have a meaningful impact on mortality, but likely a smaller impact on morbidity.
“RGA has quantified the expected mortality and morbidity impacts of incretin-based drugs, including GLP-1s, approved as anti-obesity medications (AOMs) and diabetes treatments in the U.S., U.K., Canada and Hong Kong,” they write.
The model RGA uses looks at the impact of AOMs over the next 20 years until 2045, calculating both optimistic and pessimistic scenarios, as well.
Cumulative population mortality improvements over the next 20 years in Canada are 0.7 per cent under the pessimistic scenario, 2.6 per cent under the central scenario and 6.4 per cent under the optimistic scenario, according to their analysis.
In Canada, looking at the central scenario, mortality improvements range between 1.2 per cent for those between 85 and 100 and four per cent for those between 45 and 59 years of age. Morbidity improvements in Canada range from 0.4 per cent in the pessimistic scenario to 1.5 per cent in the central scenario and 4.2 per cent in the optimistic scenario.
A fast-moving space
“This is a fast-moving space with significant uncertainty. Model assumptions will need refining as new evidence emerges and as new indications for the drugs are approved,” RGA warns in the report, Weighing the Evidence: Quantifying the mortality and morbidity impacts of GLP-1 and other incretin-based drugs in the US, UK, Canada and Hong Kong populations. It goes on to look at the growing list of indications the drugs are being used for, alongside trial names and an approval outlook for each.
The report also looks at anti-selective policyholder behaviour saying those who’ve lost considerable weight may lapse their rated policies and re-enter with better terms. “As such, insurers may not capture the full economic benefit,” they write. “As evidence accumulates, underwriting approaches must evolve.” More, they add that “accurate disclosures at the underwriting stage may need to be validated at the claims stage and claims assessors will require a deep understanding of the use of AOMs to ensure accurate interpretation of disclosures made.”
Cost, side effects and adherence
RGA goes on to look at clinical trial results and the more complex reality that includes considerations like cost, side effects and adherence: It notes that participants in studies regained approximately two-thirds of their lost weight in the year after they stopped treatment. Cardiometabolic improvements (in blood pressure, cholesterol and glucose levels) also reverted to baseline after withdrawal of the drugs in question.
Other studies also suggest that 25 to 40 per cent of weight lost on GLP-1 therapies may be lean tissue, including skeletal muscle and bone. “This is particularly problematic for older adults,” they write. “Without structured resistance training, increased protein intake and body composition monitoring, patients may lose not just fat, but vital skeletal muscle and bone – undermining long term health outcomes. As these therapies move into broader use, addressing these real-world complexities will be essential to realizing their full potential.”
