I was thinking yesterday: what if I could see into the future and the only way I would attain and maintain a healthy weight permanently would be via Mounjaro? Would I make adjustments in my monthly outgoings to ensure I could afford £250 (or whatever dreadful figure it would be for the pen in the future) per month for the rest of my life?
Would I put it at the same priority as a mortgage, or a car? Would I go without a car / get an old banger to afford Mounjaro? What other cutbacks would I be willing to make?
I've been reading some of the information that NICE has available on its website this afternoon. From what I can see, by 2027 the NHS will be able to prescribe Mounjaro to more patients than in 2025. The requirement for patients to have a BMI of 40 and 4 comorbidities will drop to a BMI of 35 and 3 comorbidities. The NHS will prescribe Mounjaro for a maximum of 2 years. This doesn't seem to be based on clinical evidence that shows a need to stop, but rather that the weight management services provided by the NHS are capped at a maximum of 2 years per patient as a cost vs benefit decision.
This section from the NICE committee discussion on Mounjaro punched me in the gut:
"In its submission, the company's model assumed that after stopping tirzepatide, the weight that had been lost was regained at a steady rate over 3 years. At 3 years after stopping treatment, weight was aligned with where it would have been had treatment not started (in line with the diet and exercise support arm endpoints).
The EAG explained that the rate of weight regain seen after stopping semaglutide treatment suggested that the time it takes for the treatment effect to be lost is closer to 2 years.
They explained that for semaglutide, around two thirds of the weight lost while on treatment is regained within the first year after stopping. Some other benefits gained, such as reduced blood pressure, are also lost by this time. "
I know there will be outliers and anomalies <polishes data analyst hat> but the vast majority aren't going to be outliers. I won't be. I am a very standard human, as soon as life gets tough I sincerely doubt I'll be crying into a bowl of salad.
Health.org have produced a report showing that health inequalities will continue to grow by 2040, underlining what we already know about the socio-economic factors regarding obesity, type 2 diabetes, heart disease and stroke. Essentially, obesity will continue to affect the population and disproportionately affect those in the most deprived areas. I find this really troubling as a whole, that I could potentially make significant changes to afford Mounjaro long-term but it would be impossible for large portions of the population. It feels morally fucked.
I'm not sure where I'm going with this. Do I want to stop Mounjaro now and write off the, what, 800 I've spent so far, knowing I can continue to goal (and spend another 12 x 240 in that time) and then regain the weight within 2-3 years after goal?
Do I want to think about incorporating this cost into my monthly outgoings for as long as it, or something like it, is available to buy privately?
Am I ok with making that commitment, knowing that I'll intentionally be part of some sort of medically-managed 'elite' that can afford it, even though many others should be given it and won't be?
This is a mess?
https://www.nice.org.uk/guidance/ta1026/chapter/3-Committee-discussion
https://www.health.org.uk/sites/default/files/upload/publications/2024/Health%20inequalities%20in%202040.pdf