Who should pay for new obesity treatments? This question may seem strange, even shocking. However, it arises when medical progress comes up against economic constraints. What is it? Obesity, defined by a body mass index greater than 30 kg/m² [NDLR : par exemple 77,5 kilos pour une taille de 1 mètre 60]concerns nearly a fifth of French adults, or more than 8 million people. We speak of severe or massive obesity when this index reaches 35 or 40 kg/m². Beyond physical and psychological discomfort, obesity is a risk factor for cardiovascular diseases, cancers and diabetes, and severe obesity reduces life expectancy by around ten years.
Until now, there was no acceptable treatment and following a low-calorie diet was very difficult. The people affected, often from disadvantaged social backgrounds, were therefore in a delicate situation. This is an important public health issue, especially since the prevalence has doubled in twenty-five years. Prevention through education, better nutrition for children, and banning the promotion of foods and drinks high in sugar are essential. But how can we help people who are already affected?
A new class of drugs, semaglutide and its derivatives, allows a loss of 10% to 25% of weight according to studies, with limited side effects. A weekly subcutaneous injection is currently necessary. The molecule acts on the brain by promoting satiety, and also seems to exert a protective effect against cardiovascular and renal diseases, at least in diabetic subjects. This is a small revolution and several manufacturers are working to further improve its performance. Of course, caution is required regarding potential long-term side effects.
A risk of social injustice
The craze is real. Novo Nordisk, the first manufacturer to market such a product, saw its turnover double between 2019 and 2023 and its profit margin reach 36%, knowing that this drug represents 90% of its activity. This company records exceptional stock market performances. The price of the treatment is around 3,000 euros per year and per patient in the European countries where it is marketed (four times more in the United States). Reimbursing it for all French patients suffering from severe obesity would cost several billion, increasing drug spending by at least 20%.
So what to do? A recent study published in The Lancet shows that several countries, including Germany and Italy, refuse to cover it, due to its price and probably also because obesity is seen as a willing risk rather than a disease, an ethically questionable concept. A minority of countries, including France, are preparing to reimburse the drug under strict conditions: very severe obesity, existence of comorbidity, age under 65 and compliance with a diet. This seems reasonable: not reimbursing this drug would lead to social injustice, as in the United States where it is mainly used by the wealthiest.
In the long term, if the interest and tolerance of this therapeutic class are confirmed, what can we envisage? Prices will undoubtedly fall, but not to the point of allowing widespread use. Purchasing a defined volume of doses or setting a maximum budget may have a beneficial but insufficient effect. This situation illustrates the problem posed by many innovative therapies, but in a very broad market context. The confrontation between medical advances and economic reality becomes acute here.
Manufacturers will argue the need to maintain a sufficient margin to continue to innovate. However, one can wonder, because the cost of producing the drug only represents 1 to 5% of the sale price. Even adding research, development and marketing costs, the profit remains very comfortable. This situation calls for an overhaul of the global system for regulating the pricing of health products, if we want to maintain a form of ethics in their access. Wishful thinking?
Alain Fischer is president of the Academy of Sciences and co-founder of the Institute of Genetic Diseases.
.