T32 Postdoctoral Fellow University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, United States
Background: The 2023 AAP guidelines support use of anti-obesity medications, including semaglutide, for adolescents with BMI>95th percentile. Few studies have evaluated the long-term health and economic consequences of early medication treatment among adolescents with obesity. Inequitable distribution of anti-obesity medications due to varying insurance coverage and healthcare access may compound existing obesity-related health disparities in youth. Objective: To measure the cost-effectiveness and equity impacts of obesity treatment for adolescents compared to usual care. Design/Methods: We developed a decision-analytic model to simulate a representative hypothetical cohort of US adolescents with obesity from age 12 until 26 years (from various sociodemographic backgrounds). Treatment options included semaglutide medication, intensive health behavioral and lifestyle treatment, bariatric surgery, diet and exercise (usual care), or no intervention. After each annual cycle in the model, adolescents with obesity can continue to have obesity, transition to no obesity, or die depending on the treatment. We modeled the usual process of receiving care and included probabilities of patients visiting their providers and receiving treatment, which vary by sociodemographic group (e.g., Medicaid-insured).
Model inputs for event probabilities, treatment effectiveness, costs (e.g., medical visits, treatment, time), and health utilities used to calculate quality-adjusted life years (QALYs) were derived from published literature and supplemented with expert panel interviews where published data were limited. We used societal and healthcare sector perspectives.
We will report outcomes including total costs, total QALYs, BMI reduction, and incremental cost-effectiveness ratios. We will report outcomes for the overall population and by sociodemographic group to estimate changes in health equity. We will perform sensitivity analysis to assess uncertainty in our results. Our findings will provide valuable insights into the impact of early obesity treatment on pediatric obesity-related health equity.
