{"id":5708,"date":"2025-05-14T08:38:00","date_gmt":"2025-05-14T08:38:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=5708"},"modified":"2025-05-14T08:38:00","modified_gmt":"2025-05-14T08:38:00","slug":"seriously-aon-you-think-weight-loss-drugs-save-money","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=5708","title":{"rendered":"Seriously, Aon, you think weight loss drugs save money?"},"content":{"rendered":"
\n<\/div>\n

By AL LEWIS<\/p>\n

Last month Aon, the major benefits consulting firm, released a \u201cstudy\u201d claiming<\/a>:<\/p>\n

A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications.<\/em><\/p>\n

This, of course, is the opposite of what most researchers have shown.\u00a0 And in the immortal words of the great philosophers Dire Straits: \u201cTwo men say they\u2019re Jesus, one of them must be wrong.\u201d We\u2019ll shortly see who\u2019s wrong (um, meaning about weight loss drugs) when we dive into the study in a minute. But first, let\u2019s review Aon\u2019s previous analyses.\u00a0<\/p>\n

A brief history of Aon<\/em><\/strong><\/p>\n

Aon claimed that Accolade saved 8%, but it looks like they must coincidentally have been absent<\/a> both on the day that the biostatistics professor explained how control groups work, and also on the day the fifth-grade math teacher explained how averages work.\u00a0<\/p>\n

Then, they claimed that Lyra<\/a> \u2013 which is a mental<\/em> health company \u2013 achieved the following non-mental<\/em> improvements in the set of patients who had at least one mental health encounter with one of their \u201c220,000 high-quality providers\u201d:<\/p>\n

\u00a7\u00a0 A <\/em>30% reduction in non<\/em>-mental health-related ER visits<\/p>\n

\u00a7\u00a0 A 30% reduction in generic drug spending<\/p>\n

\u00a7\u00a0 A 20% reduction in specialty drug spending<\/p>\n

Thanks in part to starting the y-axis at $4000 to improve the optics, Aon also revealed that Lyra achieved a very high \u201cefficiency ratio\u201d:<\/p>\n

I can\u2019t object to that finding because \u2013 despite three decades in this field, about 100 articles\/interviews\/quotes\/citations<\/a> including the Wall Street Journal<\/em><\/a>, two<\/a> trade-bestselling books<\/a> and one Harvard Business School case study<\/a> \u2013 I still don\u2019t know what an \u201cefficiency ratio\u201d is, other than that has nothing to do with comparing participants to non-participants in a mental health study. Apparently an \u201cefficiency ratio\u201d in healthcare measures how quickly<\/a> a hospital turns over its inventory. So Aon\u2019s use of the term recalls the immortal words of the great philosopher Bob Uecker: \u201cJuuussst a bit outside.\u201d<\/a><\/p>\n

When publicly and privately asked to explain any of these things, Aon clammed up. That was likely wise on their part. <\/p>\n

<\/span><\/p>\n

Nor will they respond here, because they understand the Streisand Effect<\/a>. (Barbara sued a photographer for photographing her Malibu mansion from the air as a routine part of documenting erosion along the California coastline at the behest of the state. Six people had downloaded that image before she sued. After she sued, one million<\/em> people downloaded the image. Also, she lost and had to pay attorney fees as well.)<\/p>\n

Most recently, it appears that they may have had their hand<\/a> in the PBM cookie jar as well.<\/p>\n

Aon\u2019s Weight Loss Drug Study<\/em><\/strong><\/p>\n

While admitting that costs jump in the first year, Aon found a 7% \u201cbend\u201d in the cost curve in the second year, by participants as compared to a \u201cprecisely matched control group.\u201d \u00a0Matched controls, no matter how \u201cprecise,\u201d are invalid, period<\/a>. That is why the FDA doesn\u2019t let pharma companies use them. Most famously, some Very Stable Geniuses in the wellness industry inadvertently proved this when they published this graph. They thought they were showing that participants in wellness programs saved money vs. matched non-participants. Unfortunately for them, a cursory look at the x-axis reveals the \u201ctotal savings\u201d from the aptly named \u201ctreatment\u201d started two years before the treatment started<\/em>, simply because voluntary participants are motivated.<\/p>\n

The related issue is that over a two-year period \u2013 the same duration that Aon studied \u2013 most weight loss drug users have dropped out. Yet, there is no accounting for \u2013 or mentioning of \u2013 \u00a0 dropouts in this study.<\/p>\n

Only people still on the drugs are counted. The others would be \u201clost to follow-up.\u201d Counting only the ones still in the program at the end is called \u201csurvivor bias,\u201d or the \u201clast man standing\u201d fallacy. It\u2019s why any weight loss program shows great results \u2013 most people quit most programs because they aren\u2019t succeeding. Ironically, the greater the dropout rate, generally the better the results among the few survivors.<\/p>\n

It is also quite literally impossible for costs to \u201cbend\u201d 7% overall<\/em> by reducing the rate of heart attacks and strokes by 44%. That\u2019s because there simply aren\u2019t enough of these events to do that. The rate of both is about 1 per 1000 in the <65 insured population. And Aon didn\u2019t even claim a 44% reduction in those events. They claimed to reduce the \u201crisk\u201d of these events by 44%. A cynic might observe that obviously if they did reduce actual events<\/em> by that amount, they would have said so.<\/p>\n

No need to take our word for this conclusion. We have made our Weight Loss Drug Economics Calculator<\/a> free. Enter your own assumptions and decide for yourself.<\/p>\n

How they can determine someone\u2019s risk from their claims is anyone\u2019s guess. Suppose twins have parents who died early of heart disease. The first is very concerned about this. He takes statins, metformin, maybe sees a cardiologist, gets a stent etc. The second does nothing to mitigate his genetic risk. The second is at much higher risk than the first, but the \u201crisk score\u201d will say the opposite. Many people don\u2019t even know<\/a> they are at risk for coronary artery disease until they have an event. So how can Aon know?\u00a0<\/p>\n

What is Aon up to?<\/em><\/strong><\/p>\n

Surely an actuarial consulting firm whose reputation is based on, well, being an actuarial consulting firm wouldn\u2019t risk that reputation by writing articles like these, right?<\/p>\n

Well, certainly not for free.<\/p>\n

They got paid by Lyra, got paid by Accolade, and (allegedly) got paid by Express Scripts. In this case \u2013 for anyone who doesn\u2019t feel like opening the free Weight Loss Drug Calculator above to figure out themselves \u2013 Aon will \u201cwork with employers in modeling the long-term business impact of GLP-1 adoption.\u201d<\/p>\n

And since their model is wrong, \u201cworking with\u201d Aon is \u2013 once again in the immortal words of Dire Straits \u2013 \u201cmoney for nothing.\u201d<\/p>\n

Al Lewis is CEO of <\/em>Quizzify<\/em><\/a>, Chairman of the <\/em>Validation Institute<\/em><\/a> and bete noir of the wellness industry. He blogs occasionally at <\/em>They Said What?<\/em><\/a><\/p>","protected":false},"excerpt":{"rendered":"

By AL LEWIS Last month Aon, the major benefits consulting firm, released a \u201cstudy\u201d claiming: A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications. This, of course, is the opposite of what most researchers have shown.\u00a0 And in the immortal…<\/p>\n","protected":false},"author":0,"featured_media":5703,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-5708","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/5708"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=5708"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/5708\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/5703"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=5708"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=5708"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=5708"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}