Last updated: 23/10/2024
Large scale roll-out of pharmacological interventions
Extend access to pharmacotherapy so that approximately 3 million people (BMI≥30) receive Semaglutide each year
- Very high impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 41%
- 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
- Very high cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £42bn
- Benefit to governments per year: £26bn
What is the policy?
This policy recommends that an additional 3 million more people living with obesity (BMI≥30) are treated with GLP-1 weight loss medication each year. This would approximately be extending these medications to all people living with obesity.
Recent context
Semaglutide mimics 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 National Institute for Health and Care Excellence.
| Semaglutide |
| 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. |
| Approximate cost per person, per month: £130 |
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 for large scale roll out of 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.
- Delivery pathway: Depending on the pathway through which these drugs are prescribed can affect the costs involved. We provide cost estimates for provision through primary care general practitioner (see section below on Cost and Benefits). However, if delivery is through tier 3 weight management services, then it will need investment in expanding tier 3 infrastructure and will need to consider costs for provision of services.
Estimating the population impact
We estimated that this policy would reduce the prevalence of adult UK obesity rates by approximately 41%
Estimating the per-person impact
- Semaglutide shows the highest efficacy, with weight reductions of 15.8% 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 15.8% of their body weight at the end of the two years they are on the drug. We model that 100 % of this happens in the first year and then body weight remains constant in the second year.
- We used trial data to estimate the amount of weight regained (estimated at two-thirds of initial weight loss) in the year following end of treatment. 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 in the fourth and fifth years.
- In our model we select 3 million people each year to receive the drug. The eligibility criteria is that an individual must have a BMI value of 30 or above (i.e. living with obesity). Further we also assume that individuals can be on a two year treatment only once.
- 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 3 million individuals to receive the drugs each year. Once they have received the drug for two years, they wouldn’t be eligible for it in the following years.
Estimating the population reach
We applied the effect sizes to ~13 million adults over five years who meet the current eligibility criteria (BMI >= 30).
Changes in the prevalence of people living with obesity
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 41% | Not applicable | Analysis in progress | Not applicable |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £42 billion over five years
We commissioned Health Lumen 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 of the drugs are estimated at £35 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. However, we do adjust the cost for inflation.
In addition, we assume also that the delivery of the drugs are done through primary care general practitioners and costed these using cost estimates from evidence submitted to NICE for delivery via primary care.
However, if the drugs were 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 | £35bn | 5 years | Cost of Semaglutide for approximately £1,560 for one year in 2023, adjusted for inflation in each year |
| Government | £7bn | 5 years | Delivered via primary care GPs |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £26 billion
Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of £26 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 Health Lumen to report disease incidences avoided if the policy were implemented. These estimates do not represent the total health benefits. Table 4 presents a summary of disease incidence avoided. 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 (rounded to the nearest 100).
| Disease | Incidence avoided |
| Type 2 diabetes | 29,000 |
| Hypertension | 46,000 |
| Coronary heart disease | 12,000 |
| Colorectal cancer | 4,500 |
| Gall bladder disease | 111,000 |
| Ovarian cancer | Not statistically significant |
| Stroke | 5,500 |
| Liver cancer | 800 |
| Depression | 800 |
| Musculoskeletal disease | 20,000 |
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 effect of GLP-1s as Very Strong.
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)