Google recently published its list of terms most searched for in 2024, one unsurprisingly dominated by sport, with football’s Copa America and the UEFA European Championship occupying the top two spots, followed by cricket’s ICC Men’s T20 World Cup.
What will also not be a surprise to those in the health and mortality industries is that Ozempic saw a 35% increase in searching in 2024, with 13 million searches per month, according to Glimpse; the power of social media is widely attributed to be behind the explosion of awareness of what was originally approved as a diabetes drug, as numerous celebrities touted the weight loss benefits of these drugs.
And glucagon-like peptide 1 receptor agonists (GLP-1RAs) were also the talk of the town last year in the UK’s life and health insurance and pension circles.
“Actuaries advising insurance companies and pension schemes on mortality are paying very close attention to developments with anti-obesity medicines,” said Stuart McDonald, Partner at Lane, Clark & Peacock.
More than one in four adult Brits were living with obesity in 2022 and a study by Frontier Economics published in the same year suggested that the current annual full cost of obesity in the UK is an estimated £58bn.
Anti-obesity medicines (AOMs) including Semaglutide (branded as Wegovy or Ozempic) and Tirzepatide (branded as Mounjaro) are available on the NHS for eligible patients (broadly, those with a body mass index (BMI) of greater than 35 and a weight-related comorbidity) as well as privately; a recent article in the Financial Times suggests that up to half a million Brits have already taken the plunge privately.
And, while the cohort of lives involved in bulk purchase annuity deals in the UK tend to have slightly longer life expectancies (they are healthier and wealthier on average), than the median scheme member, the higher average income is exactly why usage of these drugs could continue to see strong take-up.
“Pension scheme liabilities are typically dominated by a relatively small number of individuals with large pensions. Such individuals, where they might benefit from AOMs, are unlikely to find the cost of a private prescription prohibitive,” said McDonald.
A recent study conducted in the US found numerous other benefits of taking GLP-1RAs – the type of drug that brand names Ozempic and Wegovy are based on – and found that “compared to usual care, GLP-1RA use was associated with a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions”.
Obesity is linked to a wide range of health conditions, including cardiovascular disease, so the study results could have an even more pronounced impact on mortality. It is a welcome development in an area that, according to Nicky Draper, Director of Longevity Consulting at Crystallise, has seen slower progress in recent years.
“We witnessed remarkable gains in mortality improvements in the 1980s and 1990s through to the 2000s largely due to the management of cardiovascular disease, (CVD), such as the wider application of statins, improved surgical techniques, and reductions in smoking rates. It is thought that 60% of these gains were lifestyle driven, the remaining 40% from management of CVD. But then, things plateaued, because we achieved all we could with those specific interventions, and smoking rates are reducing at a much slower rate,” she said.
“The wider application of GLP-1RAs may well lead to an inflection point, not only in terms of cardiovascular disease, but in other indications. The ability of these drugs to tackle all parts of the metabolic pathway could have a hugely positive impact on population mortality.”
Indeed, just at the end of January, the US Food and Drug Administration (FDA) approved Ozempic for use in the fight against kidney disease, the third time the FDA has approved Ozempic for a specific reason (the first two being diabetes in 2017 and then cardiovascular disease in 2020).
“What started as a drug to help manage diabetes now seemingly has multiple applications. Sometimes, these things do come around by chance and the recent approval by the FDA for Ozempic’s use to combat kidney disease is another encouraging development for population health,” said Draper.
It is not all good, of course. The research also showed that there was “an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic disorders, nephrolithiasis, interstitial nephritis and drug-induced pancreatitis”.
And last summer, the World Health Organization published a product alert relating to three falsified batches of semaglutide, and the internet is awash with nay-sayers who caution against the use of these products.
In drug terms, we are still in the early days of understanding the micro and macro impacts of GLP-1RAs. And it will be many years until those in the medical and science industries do.
So, it is almost a given that numerous other studies will be conducted in numerous countries that analyse the pros and cons of GLP-1RAs, but the current thinking is that the impact on mortality – and consequently, the pricing of transactions in the bulk purchase annuity market and the reinsurance market – could be profound given that there would be both primary and secondary impacts of these drugs.
“I’d expect the uptake of AOMs to continue to increase rapidly around the world, to the point where they become the biggest selling drugs of all time; the widespread adoption of AOMs seems likely to directly reduce mortality rates from a significant number of causes of death,” said McDonald.
“But also, a reduced prevalence of obesity among the population could also be expected to reduce pressure on the health system, which in turn improves health and mortality outcomes.”