---
type: divergence
domain: health
description: "These are opposite cost problems from the same drug class — one assumes lifelong use drives inflation, the other shows 85% discontinuation undermines the chronic model. The answer determines payer strategy, formulary design, and the health domain's cost trajectory claims."
created: 2026-03-19
status: open
title: Is the GLP-1 economic problem unsustainable chronic costs or wasted investment from low persistence?
claims: ["GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035.md", "glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics.md"]
surfaced_by: leo
related: ["divergence-glp1-economics-chronic-cost-vs-low-persistence", "GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035", "glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics", "glp1-long-term-persistence-ceiling-14-percent-year-two", "lower-income-patients-show-higher-glp-1-discontinuation-rates-suggesting-affordability-not-just-clinical-factors-drive-persistence"]
---

# Is the GLP-1 economic problem unsustainable chronic costs or wasted investment from low persistence?

The KB holds two claims about GLP-1 economics that predict opposite problems from the same drug class. Both are backed by large datasets. Both are rated `likely`. They can't both be right about the dominant cost dynamic.

The inflationary claim assumes chronic use at $2,940+/year per patient creates unsustainable cost growth through 2035. The model depends on patients staying on treatment indefinitely — the "chronic use model" in the title.

The persistence claim shows that assumption doesn't hold: real-world data from 125,000+ commercially insured patients shows 85% discontinue by two years for non-diabetic obesity. If most patients don't sustain use, the chronic cost model breaks — but so does the therapeutic benefit.

## Divergent Claims

### Chronic use makes GLP-1s inflationary through 2035
**File:** [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
**Core argument:** Lifelong treatment at current pricing creates unsustainable spending growth. The chronic model means costs compound annually.
**Strongest evidence:** Category launch size ($50B+ projected), $2,940/year per patient, CBO/KFF cost modeling.

### Low persistence undermines the chronic use assumption
**File:** [[glp-1-persistence-drops-to-15-percent-at-two-years-for-non-diabetic-obesity-patients-undermining-chronic-use-economics]]
**Core argument:** 85% of non-diabetic obesity patients discontinue by year 2. The chronic model doesn't reflect real-world behavior.
**Strongest evidence:** JMCP study of 125,000+ commercially insured patients; semaglutide 47% one-year persistence vs 19% liraglutide.

## What Would Resolve This

- **Medicare persistence data:** Do Medicare populations (older, sicker, lower OOP after IRA cap) show better persistence than commercial populations?
- **Behavioral support impact:** Does combining GLP-1s with structured behavioral support (WHO recommendation, BALANCE Model) materially change dropout rates?
- **Cost per QALY at real-world persistence:** What's the actual cost-effectiveness when modeled with 15% two-year persistence rather than assumed chronic use?
- **Generic entry timeline:** Do biosimilar/generic GLP-1s at lower price points change the persistence equation by reducing OOP burden?

## Cascade Impact

- If chronic costs dominate: Vida's healthcare cost trajectory claims hold. Payer strategy must focus on formulary controls and prior authorization.
- If low persistence dominates: The inflationary projection is overstated. The real problem is wasted therapeutic investment and weight regain cycles. Payer strategy shifts to adherence support.
- If population-dependent: Both are right for different patient segments. The divergence dissolves into scope — diabetic patients may persist while obesity-only patients don't.

---

Relevant Notes:
- [[lower-income-patients-show-higher-glp-1-discontinuation-rates-suggesting-affordability-not-just-clinical-factors-drive-persistence]] — affordability as persistence driver
- [[semaglutide-achieves-47-percent-one-year-persistence-versus-19-percent-for-liraglutide-showing-drug-specific-adherence-variation-of-2-5x]] — drug-specific variation
- [[glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints]] — multi-organ value complicates pure cost analysis

Topics:
- [[_map]]


## Extending Evidence

**Source:** Sa et al., Diabetes Obesity and Metabolism 2026

Systematic review identifies 'short follow-up periods' as a major limitation across 80 RCTs, meaning the evidence base for continuous treatment efficacy is weaker than the continuous treatment requirement itself. This strengthens the divergence: economic models assume continuous use, but trial evidence doesn't validate long-term outcomes.
