Initiation of Semaglutide Does Not Decrease Health Care Spending

Although the initiation of semaglutide is associated with improvements in cardiovascular risks, it is also associated with higher health care expenditures, according to data from a study published in JAMA Network Open. The investigators stated that the “findings suggest potential clinical benefits in routine practice, while highlighting the need to evaluate the long-term impact of semaglutide on economic outcomes.”¹

Investigators found that health care costs rose despite the benefits seen with starting semaglutide for patients with and without diabetes. | Image Credit: Andreas Prott - stock.adobe.com

“Patients with higher baseline weight and no diabetes diagnosis experienced the most pronounced benefits. Semaglutide initiation was also associated with improvements in BP [blood pressure], total cholesterol level, and Hb [hemoglobin] A_1c level, underscoring its potential association with prevention of cardiovascular disease,” the study authors said.¹ “However, we observed an initial increase in nonsemaglutide health care expenditures after semaglutide prescriptions, which, despite a slight decrease, remained elevated over the 24-month follow-up.”

Semaglutide is a glucagon-like peptide-1 receptor agonist, which mimics the effects of the hormone in the body. It can help the pancreas produce insulin, decrease appetite, and delay gastric emptying. Furthermore, semaglutide has also shown benefits in decreasing blood glucose levels, promoting weight loss, and producing protective cardiovascular effects, according to Mayo Clinic. Regarding cardiovascular events specifically, semaglutide reduced the risk of major cardiovascular events, including heart attack and stroke, by approximately 26% for patients with diabetes and 20% for those without diabetes when compared with the placebo.²

In the current study, investigators aimed to determine the effectiveness and economic implications of semaglutide initiation to better understand obesity management and the prevention of cardiovascular diseases. They included data from 2 large integrated health systems, with one serving the Virginia and North Carolina area and the other covering Connecticut and Rhode Island. Patients were included between January 1, 2018, and January 1, 2025, and January 1, 2018, and May 1, 2025, respectively.¹

There were 23,522 individuals included with a mean age of 56.2 years at the initiation of semaglutide. Approximately 66.7% of individuals were female, 13.4% were Hispanic or Latino, 1.6% were non-Hispanic Asian, 22.6% were non-Hispanic Black, 59.5% were non-Hispanic White, and 2.9% were other or unknown race or ethnicity. Overall, the patients had reductions in body weight by 3.8%, systolic blood pressure by 1.1 mm Hg, diastolic blood pressure by 1.5 mm Hg, total cholesterol level by 12.8 mg/dL, and HbA_1c level by 0.1% in the final 12 months of follow-up. Patients without diabetes had greater reductions in body weight and systolic blood pressure, and patients with diabetes had greater reductions in HbA_1c levels, according to the investigators.¹

As for health care expenditures, there were increases after initiation of semaglutide. In the final 12-month period, total monthly expenditures increased by approximately $80, with inpatient costs accounting for approximately $43. For subgroups, patients with diabetes had an increase of $67, and those without diabetes had an increase of $81. Furthermore, the largest expenditure category was in the circulatory system.¹

One possible reason for the initial increase in health care expenditures could be due to the increased care engagement after initiation of semaglutide, such as follow-up visits, monitoring, and management of adverse effects. However, in the 24-month analysis, investigators reported that there were still no cost savings.¹

“Additional factors may also be associated with increased expenditures. For instance, semaglutide may be initiated in response to emerging symptoms or worsening clinical status, which could be independently associated with health care use even in the absence of treatment,” the study authors said. “Such potential confounding underscores the need for further research to better isolate the causal effects of semaglutide on both clinical outcomes and health care costs in clinical settings."

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REFERENCES

1. Lu Y, Liu Y, Totojani T, et al. Changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide. JAMA Netw Open. 2025;8(8):e2526013. doi:10.1001/jamanetworkopen.2025.26013

2. Buss Preszler L. Health benefits of semaglutide—beyond weight loss. Mayo Clinic Press. July 2, 2024. Accessed August 11, 2025. https://mcpress.mayoclinic.org/living-well/health-benefits-of-semaglutide-beyond-weight-loss/