Adults with obesity have more choices than ever before of therapies that reduce body mass index (BMI) and consequently improve related chronic health conditions. Bariatric procedures are among the most well-studied options with the longest follow-up. Despite achieving the greatest reductions in BMI and rates of diabetes remission, uptake of bariatric surgery remains low. Endoscopic sleeve gastroplasty (ESG), a minimally invasive approach that avoids any skin incisions, reduced BMI and improved metabolic health conditions compared with lifestyle intervention (LI) in one randomised trial, and the first devices for ESG were authorised by the US Food and Drug Administration (FDA) in 2022. However, evidence of the long-term effectiveness of ESG is limited, and the procedure is not yet covered by most health insurance plans. Glucagon-like peptide (GLP-1) agonists, initially approved for diabetes and used off-label to treat obesity, have been shown to achieve substantial weight loss and improvement in cardiovascular health. Two of these agents—liraglutide and semaglutide—and the dual incretin agonist tirzepatide are now approved for obesity treatment, and demand appears to be high. However, many questions remain about the long-term effectiveness and side effects of GLP-1 agonists for treating obesity, and they have entered the US market at list prices approaching or exceeding US$1000 per month. At an individual level, patients seeking obesity treatment may consider multiple options and make a decision based on personal preference for various attributes of the method, including the trade-off between expected benefits and harms. At a population level, when numerous options are available to manage a given condition, decision-makers are justified in questioning the value that each option provides in relation to its cost. Economic evaluation in general, and cost-effectiveness analysis specifically, are tools for answering these questions. Cost-effectiveness analysis provides an estimate of what we get—in terms of health benefit—for what we spend …

中文翻译：

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抗肥胖干预措施：选择、证据和价值

肥胖成人比以往任何时候都有更多的选择来降低体重指数 (BMI)，从而改善相关的慢性健康状况。减肥手术是研究最深入、随访时间最长的选择之一。尽管体重指数和糖尿病缓解率实现了最大程度的降低，但减肥手术的采用率仍然很低。内窥镜袖状胃成形术 (ESG) 是一种微创方法，在一项随机试验中与生活方式干预 (LI) 相比，可避免任何皮肤切口、降低体重指数并改善代谢健康状况，并且首个 ESG 设备已获得美国食品药品监督管理局 (FDA) 的授权将于 2022 年获得 FDA 批准。然而，ESG 长期有效性的证据有限，而且大多数健康保险计划尚未涵盖该程序。胰高血糖素样肽 (GLP-1) 激动剂最初被批准用于治疗糖尿病，并在标签外用于治疗肥胖症，已被证明可以实现显着的体重减轻和心血管健康的改善。其中两种药物——利拉鲁肽和索马鲁肽——以及双重肠促胰岛素激动剂替泽帕肽现已被批准用于肥胖治疗，并且需求似乎很高。然而，GLP-1激动剂治疗肥胖的长期有效性和副作用仍然存在许多问题，并且它们已以接近或超过每月1000美元的标价进入美国市场。在个人层面上，寻求肥胖治疗的患者可能会考虑多种选择，并根据个人对该方法的各种属性的偏好做出决定，包括预期利益和危害之间的权衡。在人口层面，当有多种选择可用于管理特定条件时，决策者有理由质疑每种选择相对于其成本所提供的价值。一般的经济评估，特别是成本效益分析，是回答这些问题的工具。成本效益分析提供了对我们所付出的代价所获得的健康益处的估计……