Last updated: 10/09/2024
Extend access to pharmacological interventions
Provide an extra £500 million of ring-fenced funding per year to increase access to NICE recommended weight-loss treatments (liraglutide and semaglutide)
- Moderate impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 2%
- Very high evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 5/5
- High cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £2.5bn
- Benefit to governments per year: £1bn
What is the policy?
This policy recommends providing an extra £500 million each year of ring-fenced funding to extend access to medications recommended for weight loss.
Recent context
Liraglutide and semaglutide mimic the hormone Glucagon-Like Peptide-1 (GLP-1), which regulates appetite and insulin production. They increase feelings of fullness, reduce hunger, and slow stomach emptying, promoting weight loss. Table 1 summarises the prescription guidelines and costs for each weight-loss medication taken from the National Institute for Health and Care Excellence.
| Semaglutide | Liraglutide |
| Currently prescribed to individuals with a BMI of either: – 35 or more, or 32.5 or more if from a specific ethnic group. – 30 to 34.9 (or 27.5–32.4 if from a specific ethnic group) and meets other criteria to be treated by a specialist weight-management programme. | Currently prescribed to individuals with: a BMI of 35 or more (or 32.5 or more if from a specific ethnic group). non-diabetic hyperglycaemia high risk of cardiovascular disease (eg, hypertension or high blood pressure). |
| Approximate cost per person, per month: £130 | Approximate cost per person, per month: £150 |
The use of medications for obesity treatment is relatively new in the UK, even though these drugs have been used for other conditions for longer. In England, weight-loss medications are prescribed through specialist primary, community or secondary-based services (referred via a primary care practitioner).
The recent approval of GLP-1 receptor agonists for obesity has led to increased demand and supply issues, particularly for semaglutide, marketed as Wegovy for weight loss.
In Wales and Scotland, NHS funding is devolved and influenced by the Barnett formula, which adjusts their budgets based on changes in England’s public spending. In Scotland, the Scottish Medicines Consortium has approved weight-loss drugs for restricted use within specialist services. Any ring-fenced funding for these medications would require approval from the Scottish Government and administration through NHS Scotland.
Case studies
Ring-fenced funding for GLP-1s, United States
Some states have ring-fenced funds to ensure availability of GLP-1 receptor agonists for eligible populations. Medicaid coverage for these medications varies by state, with many requiring comorbid conditions for eligibility due to their high costs. States like Mississippi, Virginia, and Michigan use a three-phase authorisation system: initial authorisation based on BMI and comorbid conditions, reauthorisation to assess progress, and maintenance authorisation to ensure the patient stays within 15% of their goal BMI. Other criteria include comprehensive lifestyle interventions, provider attestations, and trials of other weight-loss drugs.
Considerations for implementation
Implementing a policy to ring-fence funds for weight-loss medications like GLP-1 receptor agonists in the UK involves multiple considerations, especially given the differences in healthcare governance across the devolved nations:
- Funding mechanism: The NHS operates separately in each of the devolved nations, with distinct policies and funding structures. The Barnett formula determines the distribution of funds from the UK Treasury to the devolved governments. Changes in funding for NHS England could impact the budgets for NHS Scotland and NHS Wales.
- Supply issues: Implementing this policy must also address potential supply issues. The increased demand for GLP-1 receptor agonists for weight loss could affect the availability of these drugs for people with diabetes who rely on them for blood sugar control. Investment in NHS infrastructure and additional staff would be required for successful implementation.
- Weight regain: Studies indicate that patients may regain weight if they discontinue the medication. This highlights the need for long-term management plans and continuous monitoring to maintain the benefits of the treatment.
- Unknown long-term effects: The long-term safety and efficacy of these medications remain under investigation. Continuous research and post-market surveillance will be essential to understand the potential long-term health impacts and to update treatment guidelines accordingly.
Estimating the population impact
We estimated that this policy would reduce the prevalence of adult UK obesity rates by approximately 2%
Estimating the per-person impact
- Liraglutide demonstrates an 8% weight reduction over 56 weeks, with some studies extending up to 160 weeks showing sustained, though slightly diminished, weight loss. Semaglutide shows the highest efficacy, with weight reductions of 15% over 68 weeks. View a summary of the studies that informed our model, and our method for identifying the data.
- We assumed therefore that those receiving any one of the two drugs would lose an average of 11% of their body weight at the end of the two years they are on the drug. We model that 100% of the weight loss occurs in the first year and the body weight stays stable in the second year.
- We used trial data to estimate the amount of weight regained (estimated at two-thirds of initial weight loss) when people are weaned off the drug. This means that individuals who were taken off the drugs after their two-year treatment period regained two-thirds of their lost body weight in the following year. We don’t have information on their body weight trajectory beyond the third year. Our model implements this as described and assumes that body weight plateaus after the two-thirds weight regain in the fourth and fifth years.
- We used the average prescription cost of the two drugs, as well as the average length of time each drug is prescribed for, to estimate how many additional individuals would be in receipt of a weight-loss medication following policy implementation.
- We estimated that additional funding of £500 million would result in approximately 150,000 additional adults being prescribed weight-loss medications per year.
- From the health survey data (Health Survey for England), we identified all individuals that meet the eligibility criteria and from the eligible group we randomly chose 150,000 individuals to receive the drugs.
Estimating the population reach
We applied the effect sizes to ~150,000 adults who have a BMI greater than or equal to 30 or are have a BMI of 27.5 and above and are of Asian or Black ethnicity.
Changes in the prevalence of people living with obesity
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 2% | Not applicable | 1% | Not applicable |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £2.5 billion over five years
We commissioned HealthLumen to estimate the cost of the policy to both industry and governments over a five-year period.
Table 3 below shows a breakdown of costs. The direct costs to the governments are estimated at approximately £500 million per year (£2.5 billion over 5 years). In our modelling we assume that the cost of GLP-1s remains stable over the five-year period, and does not significantly decrease in price when removed from patent.
We propose that the delivery of the drugs will be done via primary care general practitioners and nurses. Given the relatively smaller scale of the policy (reaching approximately 150,000 people per year) and the high probability that it would be existing patients receiving the drugs, it is unlikely to have a big impact on existing primary care services. Therefore, we have not costed for this in our estimates.
However, if the drugs are to be delivered through Tier 3 weight management services, then there would be a need to make allocations for expanding the services to accommodate the additional patient load. We have not estimated the costs for this route.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £2.5bn | Annual (5 years) | Increased provision of funding (£500m per year, for 5 years) |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £1 billion
Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of approximately £1 billion per year. Approximately two-thirds of this saving would benefit individuals (via quality-adjusted life years, and informal social care). The remaining third relates to savings that benefit the state via NHS treatment costs, productivity and formal social care. See our Methods page for more information about the cost breakdowns.
Impact on disease incidence
We commissioned HealthLumen to report disease incidence avoided if the policy were implemented. These estimates do not represent the total health benefits. The specific diseases selected are those where there is good evidence that living with obesity is associated with the development of the disease.
Table 4 presents a summary of disease incidence avoided.
| Disease | Incidence avoided |
| Type 2 diabetes | Not statistically significant |
| Hypertension | Not statistically significant |
| Coronary heart disease | Not statistically significant |
| Colorectal cancer | Not statistically significant |
| Gall bladder disease | 5,600 |
| Ovarian cancer | Not statistically significant |
| Stroke | Not statistically significant |
| Liver cancer | Not statistically significant |
| Depression | Not statistically significant |
| Musculoskeletal disease | Not statistically significant |
Behind the averages: impact on inequalities
Financial inequalities: Most people are only able to access weight-loss medications through the NHS, and are not in a financial position to pay for private access. As such, the private cost combined with the constrained capacity of NHS weight management services could exacerbate health inequalities in the short term, with the wealthiest able to access the treatments and the poorest not.
Other health conditions: The NHS is facing ongoing supply challenges with GLP-1 receptor agonists medications, which are used to manage blood glucose levels in people with type 2 diabetes. This shortage is partly driven by a significant increase in off-label prescriptions of semaglutide for weight loss, resulting in demand that exceeds supply.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated the evidence base for the effectiveness of GLP-1s as Very Strong.
Large scale roll-out of pharmacological interventions
Extend access to pharmacotherapy so that approximately 3 million people (BMI≥30) receive Semaglutide each year