Glucagon-like peptide-1 receptor agonists and healthcare use in older adults with heart failure and obesity
Among older adults with heart failure and obesity, adding GLP-1 RA to standard therapy may reduce hospital admissions and medical costs, despite higher medication expenses.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This study examined the association of glucagon-like peptide-1 receptor agonists (GLP-1 RA) with healthcare resource utilization in Medicare Advantage beneficiaries with heart failure and obesity. The cohort included 4,677 matched pairs receiving standard heart failure therapy or therapy plus GLP-1 RA. Results indicated reduced inpatient admissions and lower medical costs with the addition of GLP-1 RA.
Abstract
<h4>Background</h4> Glucagon-like peptide 1 receptor agonists (GLP-1 RA) are indicated for weight reduction and offer cardiometabolic health benefits, yet there is little real-world evidence regarding their association with healthcare resource utilization (HCRU) and costs for Medicare Advantage (MA) beneficiaries with heart failure and obesity. <h4>Methods</h4> We used a prevalent new-user study design and the Humana Healthcare Research database to identify MA beneficiaries with heart failure (HF) and obesity receiving standard HF therapy or HF therapy + newly initiating GLP-1 RA between January 1, 2022, and December 31, 2023. We observed adjusted, one-year mean difference in all-cause and heart failure-related HCRU. <h4>Results</h4> In our cohort of 4,677 matched pairs (mean age 72 years, male: 41%), one-year, adjusted risk ratio (RR) for HF therapy + GLP-1 RA vs HF therapy was 0.89 (95% CI: 0.84 – 0.93) for all-cause inpatient utilization, 0.88 (95% CI: 0.82 – 0.94) for avoidable hospitalizations, and 0.99 (95% CI: 0.95 – 1.03) for emergency department visits. For individuals receiving HF therapy + GLP-1 RA vs HF therapy, the mean difference was 30.6% (95% CI: 26.7% –34.7%) for all-cause total costs, 105.9% (95% CI: 99.1% –112.9%) for pharmacy costs, and −4.7% (95% CI: −8.7% to −0.6%) for medical costs. HF-related HCRU measures were lower among beneficiaries augmenting HF therapy with GLP-1 RA vs individuals receiving HF therapy alone. <h4>Conclusions</h4> Among MA beneficiaries with heart failure and obesity, the addition of GLP-1 RA to standard heart failure therapy reduced the likelihood of inpatient admissions or avoidable hospitalizations compared with HF therapy alone. <h4>Clinical perspective</h4> <h4>What is new?</h4> Among older Medicare beneficiaries with heart failure and obesity, augmenting standard HF therapy with GLP-1 RA was associated with better disease control, less need for acute care, and lower medical costs, but increased all-cause expenditure due to higher medication costs. This study builds upon prior analyses by examining newer GLP-1 RA agents, including semaglutide and tirzepatide, and an older adult population at higher risk for poor outcomes. <h4>What are the clinical implications?</h4> This real-world evidence study suggests that the health benefits of GLP-1 RA use, as demonstrated by clinical trials, extend to observed improvements in utilization and economic outcomes.