Economics-heavy pieces usually lose my attention fast, but GLP's are already shifting things, and the changes ahead will be far bigger. Over the last year, bariatric surgery has fallen by roughly 20-30%, and regardless of how good GLP's are, surgery still beats them on long-term outcomes for conditions such as diabetes or heart disease. Whether going under the knife makes sense today is a separate matter; at least with grey GLP's, reta or tirz plus elora could work just as well, with far less of the surgery's unpleasantness and fewer long-term adverse effects. Still, surgeons have been publishing a great many papers lately arguing that weight loss surgery outperforms GLP's, so the danger to their livelihoods is genuine and I believe it worries them.
The cost of the GLP's is the glaring flaw in every cost effectiveness study I have come across. They cut long-term health care costs substantially. Even if you see your doctor more frequently while taking them, the serious money in health care goes to hospital treatment of serious illness or, worse, aged care. And roughly half of lifetime healthcare costs are spent in the last 6 months of life. Preventing, or merely postponing, a large share of heart attacks, strokes, bypass operations, cancers and possibly dementia lowers long-term health care costs enormously, yet the payoff may be a decade out for the patient, the insurance company or a government, while the upfront costs are large and continuous. So if retail tirz runs $700/month, whoever pays must see those long-term costs fall by $84000 over the next decade, and must commit to the upfront and ongoing investment.
The Australian government will not fund them on a broad scale anytime soon. Even if the cost benefit analysis looked good, paying $700 a month for tirz for up to 1/3 the population would wreck the healthcare budget, so whatever subsidies exist cover semaglutide only and are tightly targeted at limited very high risk groups, where the illness-prevention payoff arrives sooner than a decade away.
Prices in China have already come down since their homegrown GLP was released; I read that tirz and sema prices there dropped 50-70% in response. I am not sure whether generic sema is available in Canada yet or what it costs, but sema at least will be off patent in many places soon, just not the US or Australia. Meanwhile the number of GLP's and related weight loss drugs in development is insane. Not all will make it, and of those arriving soon, most are ones we already know about and will not be cheap, like reta or cagri or elora, but plenty of others are 2 to 4 years away. Once there are a lot of them, I simply cannot see how prices stay so high, unless China does not even try to market them in the west, leaving us with expensive GLP's while the rest of the world gets cheap ones. That would no doubt produce a new different grey market for GLP's.