From 86d13a961acf59da7aaf1444d2a3f78d1b793ec8 Mon Sep 17 00:00:00 2001 From: Teleo Agents Date: Mon, 16 Mar 2026 12:50:56 +0000 Subject: [PATCH] auto-fix: strip 5 broken wiki links Pipeline auto-fixer: removed [[ ]] brackets from links that don't resolve to existing claims in the knowledge base. --- ...l makes the net cost impact inflationary through 2035.md | 6 +++--- ...ons-because-10-year-window-excludes-long-term-savings.md | 2 +- ...-across-kidney-cardiovascular-and-metabolic-endpoints.md | 2 +- 3 files changed, 5 insertions(+), 5 deletions(-) diff --git a/domains/health/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 b/domains/health/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 index e62cb2268..78f151db8 100644 --- a/domains/health/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 +++ b/domains/health/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 @@ -19,19 +19,19 @@ The competitive dynamics (Lilly vs. Novo vs. generics post-2031) will drive pric ### Additional Evidence (extend) -*Source: [[2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations]] | Added: 2026-03-15 | Extractor: anthropic/claude-sonnet-4.5* +*Source: 2024-08-01-jmcp-glp1-persistence-adherence-commercial-populations | Added: 2026-03-15 | Extractor: anthropic/claude-sonnet-4.5* Real-world persistence data from 125,474 commercially insured patients shows the chronic use model fails not because patients choose indefinite use, but because most cannot sustain it: only 32.3% of non-diabetic obesity patients remain on GLP-1s at one year, dropping to approximately 15% at two years. This creates a paradox for payer economics—the "inflationary chronic use" concern assumes sustained adherence, but the actual problem is insufficient persistence. Under capitation, payers pay for 12 months of therapy ($2,940 at $245/month) for patients who discontinue and regain weight, capturing net cost with no downstream savings from avoided complications. The economics only work if adherence is sustained AND the payer captures downstream benefits—with 85% discontinuing by two years, the downstream cardiovascular and metabolic savings that justify the cost never materialize for most patients. ### Additional Evidence (extend) -*Source: [[2025-06-01-cell-med-glp1-societal-implications-obesity]] | Added: 2026-03-15* +*Source: 2025-06-01-cell-med-glp1-societal-implications-obesity | Added: 2026-03-15* The Cell Press review characterizes GLP-1s as marking a 'system-level redefinition' of cardiometabolic management with 'ripple effects across healthcare costs, insurance models, food systems, long-term population health.' Obesity costs the US $400B+ annually, providing context for the scale of potential cost impact. The WHO issued conditional recommendations within 2 years of widespread adoption (December 2025), unusually fast for a major therapeutic category. ### Additional Evidence (extend) -*Source: [[2025-03-01-medicare-prior-authorization-glp1-near-universal]] | Added: 2026-03-15* +*Source: 2025-03-01-medicare-prior-authorization-glp1-near-universal | Added: 2026-03-15* MA plans' near-universal prior authorization creates administrative friction that may worsen the already-poor adherence rates for GLP-1s. PA requirements ensure only T2D-diagnosed patients can access, effectively blocking obesity-only coverage despite FDA approval. This access restriction compounds the chronic-use economics challenge by adding administrative barriers on top of existing adherence problems. diff --git a/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md b/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md index 1ea98d315..435dcf3dd 100644 --- a/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md +++ b/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md @@ -41,7 +41,7 @@ The claim that budget scoring "systematically" undervalues prevention requires e ### Additional Evidence (confirm) -*Source: [[2024-11-01-aspe-medicare-anti-obesity-medication-coverage]] | Added: 2026-03-16* +*Source: 2024-11-01-aspe-medicare-anti-obesity-medication-coverage | Added: 2026-03-16* The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidence: CBO projects $35B in additional spending (2026-2034) using budget scoring methodology, while ASPE projects net savings of $715M over 10 years using clinical economics methodology that includes downstream event avoidance. The $35.7B gap between these estimates demonstrates how budget scoring rules structurally disadvantage preventive interventions. CBO uses conservative uptake assumptions and doesn't fully count avoided hospitalizations and disease progression within the 10-year window, while ASPE includes 38,950 CV events avoided and 6,180 deaths avoided. Both are technically correct but answer different questions—budget impact vs. clinical economics. diff --git a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md index 21a350d1e..646138441 100644 --- a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md +++ b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md @@ -32,7 +32,7 @@ For value-based care models and capitated payers, this multi-organ protection cr ### Additional Evidence (extend) -*Source: [[2025-12-23-jama-cardiology-select-hospitalization-analysis]] | Added: 2026-03-16* +*Source: 2025-12-23-jama-cardiology-select-hospitalization-analysis | Added: 2026-03-16* SELECT trial exploratory analysis (N=17,604, median 41.8 months) shows semaglutide reduces ALL-CAUSE hospitalizations by 10% (18.3 vs 20.4 per 100 patient-years, P<.001) and total hospital days by 11% (157.2 vs 176.2 days per 100 patient-years, P=.01). Critically, benefits extended beyond cardiovascular causes to total hospitalization burden, suggesting systemic effects across multiple organ systems.