Cost-Effectiveness and Policy Implications of Knee Osteoarthritis, Obesity Treatment: Elena Losina, PhD

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With Medicare drug coverage reviews approaching in the next few years, the higher cost-effectiveness of the glucagon-like peptide 1 receptor agonist (GLP-1 RA) tirzepatide compared with semaglutide could play an important role in shaping payer decisions.

A recent study published in The Annals of Internal Medicine found that tirzepatide was more cost-effective than semaglutide when treating patients with knee osteoarthritis and obesity, but both were less cost-effective than bariatric surgery and diet and exercise.¹ Medicare currently does not cover GLP-1 RAs for weight loss without an obesity-related health condition like high cholesterol or high blood pressure.² However, if upcoming price negotiations for Medicare Part D via CMS drive down the cost of semaglutide, its value profile for weight loss in patients with knee osteoarthritis may improve, potentially altering its competitiveness against tirzepatide and influencing future access.

The American Journal of Managed Care^® spoke with corresponding author Elena Losina, PhD, codirector of the Orthopedics and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital, on the future implications of the negotiations and what it would mean for payers to adopt coverage of GLP-1 RAs for patients with knee osteoarthritis and obesity.

“Lowering the prices will increase the appetite for payers to consider coverage of those medications, because right now, the cost of those medications is the barrier for a number of payers to consider coverage,” Losina said. “Again, we're not talking about covering these medications, which are covered for specific indications, such as diabetes and some of the cardiovascular diseases, but for osteoarthritis. It's not covered for [the] weight loss indication, and so from that point of view, our analysis, I hope, provides data that could be used by payers and could be used by negotiators.”

While the likelihood of US payers adopting coverage of anti-obesity drugs for patients with knee osteoarthritis is unknown, Losina’s research still provides vital evidence that can serve as guidance in future negotiations.

“CMS, Medicare, and Medicaid are the largest providers of care for people with knee osteoarthritis, and obesity and knee osteoarthritis, because it occurs later in life,” Losina said. “So, these payers have some guidance ideas on how they make those coverage decisions.”

Current treatment for knee osteoarthritis covered by Medicare includes hyaluronic acid (HA), which lubricates the joint and absorbs shocks. The most recent analysis estimated an incremental cost-effectiveness ratio, or ICER, of $54,500 per QALY for HA—reduced to $22,400 per lifetime quality-adjusted life-year, or QALY, when saline was excluded as a comparator. Placed alongside newer interventions like GLP-1 RAs and bariatric surgery, these findings highlight how treatment value varies widely depending on comparator and cost assumptions, shaping payer decisions moving forward.⁴

“Ideally, it would be great if the United States would have a unifying threshold for cost-effectiveness; it will make those decisions more transparent, but to recognize that different payers may have different considerations between the value and affordability and increases in premiums,” Losina said.

Comparing interventions for knee osteoarthritis shows how cost-effectiveness varies widely, from established treatments like hyaluronic acid injections to newer options such as GLP-1 RA and bariatric surgery. While HA demonstrates modest value within accepted thresholds, GLP-1 RA therapies like tirzepatide and surgical interventions may deliver greater long-term benefits depending on pricing and payer benchmarks. These findings underscore the importance of aligning treatment decisions with both clinical outcomes and economic considerations to optimize patient care and access.

References

1. Betensky DJ, Smith KC, Katz JN, et al. The cost-effectiveness of semaglutide and tirzepatide for patients with knee osteoarthritis and obesity. Ann Intern Med. Published online September 16, 2025. doi:10.7326/ANNALS-24-03609

2. Does insurance cover prescription weight loss injectables? National Association of Insurance Commissioners. August 31, 2024. Accessed September 15, 2025. https://content.naic.org/article/does-insurance-cover-prescription-weight-loss-injectables

3. Hyaluronic acid injections for knee osteoarthritis. CMS. Accessed September 15, 2025. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39260&ver=5

4. Mass H, Collins JE, Yang C, et al. Intra-articular injections for knee osteoarthritis management: analysis of cost-effectiveness. Osteoarthr Cartil Open. 2025;7(3):100641. doi:10.1016/j.ocarto.2025.100641

4. Joszt L, Beardsley HJ, Hussain F. The complexities of Medicare Part B drug negotiations vs Part D: H. John Beardsley and Fauzea Hussain. AJMC^®. June 4, 2025. Accessed September 15, 2025. https://www.ajmc.com/view/the-complexities-of-medicare-part-b-drug-negotiations-vs-part-d-h-john-beardsley-and-fauzea-hussain