Cost-Effectiveness of Pharmacologic Treatments in Adults With Overweight or Obesity: A Systematic Review for the American College of Physicians

Background: A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. Purpose: To evaluate cost-effectiveness of pharmacologic treatments in adults with overweight or obesity in a U.S. setting. Data Sources: MEDLINE, Embase, and economic databases, searched on 13 October 2025. Study Selection: Non–industry-sponsored U.S. trial-based and model-based cost-effectiveness evaluations of pharmacologic treatments in adults with overweight or obesity. Data Extraction: Data on clinical characteristics, economic characteristics (for example, model type), and study outcomes were extracted by one reviewer and verified by a second reviewer. Study quality was assessed using the CHEQUE (Criteria for Health Economic Quality Evaluation) tool; value was assessed using incremental cost-effectiveness ratios (ICERs), with thresholds for high value (<$100 000 per quality-adjusted life-year [QALY], or dominant), intermediate value ($100 000 to $200 000 per QALY), low value (>$200 000 per QALY), and no value (strict or extended dominance, or less costly and less effective); and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Data Synthesis: Four out of 9 included studies were at low risk of bias. None of the 42 pairwise comparisons that were reported had high certainty. In the 6 studies with moderate certainty, liraglutide had low value and phentermine–topiramate and tirzepatide had high value when each was compared with lifestyle modification. Semaglutide had low value compared with naltrexone–bupropion and phentermine–topiramate and high value compared with liraglutide. Limitations: All studies were model-based. ICERs were not reported for all potential treatment comparisons. Most studies had incomplete reporting or were at high risk of bias. Conclusion: Current evidence on cost-effectiveness of pharmacologic treatment of overweight or obesity is hampered by poor-quality studies, limiting the ability to draw conclusions.