An analysis of barriers and disparities in access to Semaglutide in metabolic bariatric surgery patients
*Katherine Wasden1, *Pourya Medhati2, *Vasundhara Mathur2, *Thomas Shin2, Abdelrahman Nimeri2, Ali Tavakkoli2, Eric Sheu2
1. Harvard Medical School, Brookline, MA, United States. 2. Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women's Hospital, Boston, MA, United States.
Objective: To determine barriers to access to Semaglutide for metabolic bariatric surgery (MBS) patients and whether demographic or socioeconomic disparities exist for those who do or do not successfully start medication. Design: We performed a retrospective study of 494 bariatric surgery patients prescribed Semaglutide. Demographics, co-morbidities, insurance coverage, and medication utilization were extracted from the electronic medical record. Median income was extrapolated from patient zip code using US Census Bureau data. Setting: The analyzed patient population received care within a large tertiary care hospital system (encompassing 5 individual hospitals). Patients: Patients analyzed were those prescribed Semaglutide between 2018-2023 by a provider within the hospital system, and who underwent MBS. 445 (90%) of patients had MBS before starting Semaglutide, and 49 (10%) started Semaglutide before undergoing MBS. Intervention: No intervention. Main Outcome Measures: Primary outcome measured was whether or not a patient started Semaglutide after they were prescribed the medication, and the length of time between date of prescription and medication start date. Secondary measures included patient or physician documented reasons for experiencing a delay in starting or not starting the medication. Results: Patients prescribed Semaglutide were primarily female, non-Hispanic, non-diabetic, post-MBS, and actively engaged in our multi-disciplinary center. Primary reason for never taking or having a delay in receiving Semaglutide were insurance denial (74%, 55%). On univariate analysis, there were no significant differences in age, gender, race, BMI, or diabetes status between patients who did or did not start Semaglutide. The odds of starting the medication were 60% lower in pre-MBS patients compared to post-MBS (OR= 0.398, p=0.014). Patients were more likely to take Semaglutide if they had private versus public insurance (83% vs 72%, p=0.015); however, despite differences in income among races (p<0.001), median income did not affect access to Semaglutide. In multivariate analysis, among patients who did take medication, Black patients were more likely to have a longer delay before starting Semaglutide (OR=2.52, p=0.029). Conclusions: In MBS patients prescribed Semaglutide at our institution, insurance is the primary barrier to obtaining Semaglutide. No association of race, ethnicity and income with taking Semaglutide was observed, although Black patients experienced more delays in initiating treatment. Future studies are needed to understand barriers and disparities in access to medical obesity treatment for all patients.
Characteristics of Bariatric Surgery Patients Based on Access to Semaglutide
| Never Took Semaglutide (n=90) | Took Semaglutide (n=404) | p | Delay < 1 month (n=297) | Delay > 1 month (n=106) | p | |
| Gender | 0.3980 | >0.9999 | ||||
| Female | 73 (82%) | 315 (78%) | 231 (78%) | 83 (78%) | ||
| Male | 16 (18%) | 89 (22%) | 66 (22%) | 23 (21%) | ||
| Race | 0.4078 | 0.1350 | ||||
| White | 65 (72%) | 306 (76%) | 231 (78%) | 74 (70%) | ||
| Non-White | 24 (27%) | 90 (22%) | 61 (21%) | 29 (27%) | ||
| Ethnicity | 0.0788 | 0.2113 | ||||
| Non-Hispanic | 69 (77%) | 347 (86%) | 257 (87%) | 89 (84%) | ||
| Hispanic | 9 (10%) | 21 (5%) | 13 (4%) | 8 (8%) | ||
| Income | 0.3006 | 0.2848 | ||||
| Low | 7 (8%) | 22 (5%) | 16 (5%) | 6 (6%) | ||
| Middle | 37 (41%) | 140 (35%) | 97 (33%) | 43 (41%) | ||
| High | 46 (51%) | 240 (60%) | 184 (62%) | 56 (53%) | ||
| Insurance | 0.0152 | 0.8088 | ||||
| Private | 63 (72%) | 333 (83%) | 246 (83%) | 87 (82%) | ||
| Public | 25 (28%) | 69 (17%) | 50 (17%) | 19 (18%) | ||
| Average BMI | 40.4 ± 8.4 | 39.1 ± 8.0 | 0.1848 | 38.9 ± 8.0 | 39.7 ± 8.0 | 0.3473 |
| Diabetes Status | 0.2945 | 0.9952 | ||||
| No | 57 (64%) | 232 (57%) | 169 (57%) | 61 (58%) | ||
| Pre-diabetes | 8 (9%) | 31 (8%) | 23 (8%) | 8 (8%) | ||
| Type 2 | 22 (25%) | 135 (33%) | 99 (33%) | 36 (34%) | ||
| Medication Timing | 0.0179 | 0.6670 | ||||
| After MBS | 75 (83%) | 370 (92%) | 273 (92%) | 96 (91%) | ||
| Before MBS | 15 (17%) | 34 (8%) | 24 (8%) | 10 (9%) |
Delay references time between date of prescription and medication start date. MBS: Metabolic bariatric surgery.
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