A review of economic studies found that weight‑loss drugs like semaglutide and liraglutide usually aren’t worth the price for treating obesity in people without diabetes, at least in high‑income countries, though they might pay off for some groups over a very long time.

To pool the incremental net benefits (INBs) of using glucagon-like peptide-1 receptor agonists (GLP-1RAs) for treating obesity without diabetes. PubMed, Embase, EconLit, CEA Registry, ProQuest Dissertation and Theses Global were searched from inception to April 2024. Cost-effectiveness studies were included if they reported economic outcomes of any GLP-1RAs in the treatment of obesity without diabetes for a minimum time horizon of 5 years. Details of the study characteristics, economic model inputs, costs, and outcomes were extracted. Monetary units were converted to 2023 US dollars. INBs with 95% confidence interval (CI) were pooled using a random-effects model. Statistical heterogeneity between studies was assessed using the I² statistic. The outcome was INB, calculated by multiplying the willingness-to-pay threshold by the difference in effectiveness between two interventions, then subtracting the difference in costs, with a positive INB indicating cost-effectiveness. Of 634 studies identified, 9 from high-income countries (HICs) with 23 comparisons were included. The pooled INB demonstrated that semaglutide and liraglutide were not cost-effective compared to no intervention (-$3659 [95% CI, -$74 379 to $67 062] and -$32 032 [95% CI, -$101 534 to $37 488], respectively) and lifestyle interventions (-$84 060 [95% CI, -$152 645 to -$15 475] and -$70 563 [95% CI, -$106 520 to -$34 605], respectively). GLP-1RAs are generally not cost-effective for obesity treatment in patients without diabetes in HICs from a healthcare/payer perspective. However, they may be cost-effective in subgroups evaluated over longer time horizons. Most included studies focused on weight-related outcomes, potentially underestimating the broader economic value of GLP-1RAs. This pooled economic evidence may inform the decision-making process.