Projected budget impact of pharmacotherapy scenarios for obesity and related conditions in Peru: A national survey analysis of 76,819 participants.

BACKGROUND: The increasing prevalence of obesity is generating demand for chronic pharmacologic treatment, but Latin American evidence on population-level budget implications remains limited. METHODS: This was an observational, cross-sectional descriptive study using ENDES (Encuesta Demográfica y de Salud Familiar or Demographic and Family Health Survey) 2022-2024 data, with a deterministic scenario-based budget impact analysis component. Survey-observable candidate populations and gross medication-acquisition requirements were estimated under the complex survey design. Liraglutide, extended-release naltrexone/bupropion, and extended-release phentermine/topiramate were modeled, while semaglutide 2.4 mg served as a supplementary non-governmental retail scenario. RESULTS: The pooled file included 76,819 records. An estimated 7.54 million adults had Body Mass Index-defined obesity, 9.04 million met the broad criterion, and 3.67 million met pragmatic priority. At 100% coverage, broad-criterion annual budgets were S/142.95 billion for liraglutide, S/23.65 billion for the IETSI (Institute for Health Technology Assessment and Research)-reported naltrexone/bupropion scenario, and S/26.83 billion for phentermine/topiramate; corresponding pragmatic-priority budgets were S/57.95 billion, S/9.59 billion, and S/10.88 billion. Semaglutide 2.4 mg cost S/16,804.86 per patient in the first year and S/18,135.52 in a maintenance year. CONCLUSION: In Peru, a substantial proportion of adults meet survey-observable criteria for treatment with obesity medications. The broad criterion reaches more than nine million adults, whereas pragmatic priority reduces the initial candidate population to nearly four million. Projected budget impact is driven primarily by candidate-population size and annual medication cost. Liraglutide 3.0 mg and semaglutide 2.4 mg represent high-cost non-governmental retail scenarios rather than expected institutional procurement estimates. Extended-release naltrexone/bupropion provides a lower-cost non-GLP-1 comparator,and extended-release phentermine/topiramate was analyzed only as an exploratory supplementary comparator.