It’s almost funny. Except it’s not. This is deadly serious for people whose entire lives are shaped by obesity – people who need better access to care. The influential Institute for Clinical and Economic Review (ICER) issued a new draft report on the cost effectiveness of semaglutide and tirzepatide. In a nutshell, the report says these obesity medicines offer great value, but they’re too darn costly.

The executive summary from ICER tells us:

“Despite these therapies being highly cost-effective, their potential budget impact is large. We estimate that fewer than 1% of eligible patients could be treated at current and assumed net prices before crossing the ICER budget impact threshold of $880,000,000 annually. This raises serious concerns about affordability.”

This is an economist’s version of an old, dysfunctional trope we heard for years. It was an excuse for not facing up to the health problem of obesity:

“Prevention is the only answer for obesity, because there’s just too much of it to treat.”

That thought has meant for decades that we did nothing but tell people to eat less and move more while obesity rates soared.

Money We Already Spend

David Rind, Chief Medical Officer for ICER, captured the essence of this divided view on these medicines, saying:

“These are great drugs but we don’t have $600 billion a year to spend on them,”

Let’s be clear about the hyperbole in that statement. Serious analysts don’t expect for a minute that we will be spending $600 billion on obesity medicines anytime in the next decade. The wildest predictions top out at a fourth of that. Hype is a lousy foundation for policymaking.

But the fact is that we are already spending hundreds of billions of dollars on the chronic diseases that come from obesity: heart disease, diabetes, cancer, liver disease, kidney disease, osteoarthritis, and more. The list goes on to include more than 200 chronic diseases resulting from obesity. In 2016, direct medical costs added up to $481 billion and the total economic impact was $1.7 trillion.

Can’t afford it? Well, we’re already spending the money, but not getting much health for it. This is a big part of the reason that chronic diseases cost the U.S. economy trillions of dollars.

Bias at the Heart of It

The real problem here is that even with the best of intentions, most of us implicitly devalue persons living with obesity. That’s what makes it possible look past the absurdity of saying “these medicines are valuable, but they’re just too costly.” It’s an oxymoron that flows from implicit bias. The quiet part that nobody says out  loud is “those people aren’t worth it.”

That needs to stop.

Click here for the new ICER report, here, here, and here for further reporting on it.

Janus, detail of a fresco in the Aula Gotica of Santi Quattro Coronati in Rome / Wikimedia Commons