Cost-Effectiveness of Access to Obesity Care and Treatments for Adolescents.

BACKGROUND: Inadequate care access may exacerbate the childhood obesity epidemic. Obesity treatments are recommended for adolescents, but the health-economic impacts of unequal treatment access are unclear. This study aims to evaluate the cost-effectiveness of improving access levels to adolescent obesity care and treatment. METHODS: In this economic evaluation, we used a decision-analytic model to simulate a synthetic cohort of 1000 US adolescents from ages 12 to 26 on an annual basis. Modeled treatment strategies included phentermine-topiramate, semaglutide, bariatric surgery, and lifestyle modification (usual care). Primary analysis modeled perfect care access for reproducibility with prior studies. Secondary analyses modeled imperfect access to primary care visits, specialty visits, and treatment initiation among distinct groups by insurance coverage or race and ethnicity. Uncertainty analyses tested model parameter estimates. Outcomes were costs, health effects [averted obesity cases, quality-adjusted life years (QALYs)], and incremental cost-effectiveness ratios (ICERs) from health care sector and limited societal perspectives, including caregiver time. RESULTS: Phentermine-topiramate (vs. lifestyle) yielded an ICER of 2025 US$112,141/QALY, and semaglutide (vs. phentermine-topiramate) yielded $166,513/QALY under perfect access. Under imperfect access, cost-effectiveness and health gains were reduced. Cost-effectiveness was reduced by 11%, and averted obesity cases decreased from 57% to 3% for semaglutide. Health gains were lowest in Medicaid-insured, Black, or Hispanic youth. ICERs were sensitive to medication characteristics (costs, efficacy, discontinuation) and health utilities. CONCLUSIONS: In this economic evaluation, phentermine-topiramate and semaglutide were cost-effective under $200,000/QALY, using 2025 pricing. Care access disparities limit health-economic gains for adolescents. Improving care access is critical to addressing the childhood obesity epidemic.