Abstract
Obesity represents a major global health challenge, requiring interventions that are both effective and economically sustainable. This review examines the cost-effectiveness of commonly discussed treatment options: glucagon-like peptide-1 receptor agonists (GLP-1 RAs), endoscopic sleeve gastroplasty (ESG), and metabolic/bariatric surgery (MBS). We synthesized evidence from published clinical studies and economic analyses, comparing incremental cost-effectiveness ratios (ICERs) and cost per quality-adjusted life year across obesity severity classes, with particular consideration of implications for Korea's healthcare context. Clinical trial data indicate that GLP-1 RAs can achieve approximately 15-20% weight reduction, but high cost often places ICERs above conventional willingness-to-pay benchmarks. ESG, a less invasive endoscopic procedure, yields around 15% weight loss and has demonstrated favorable cost-effectiveness, particularly in class I obesity. MBS offers the most durable weight loss, generally 25-30%, along with improvements in survival and quality of life. Economic evaluations consistently report MBS as highly cost-effective-and in some cases cost-saving-especially for class II and III obesity. Comparative findings suggest that ESG is generally more economically favorable than GLP-1 RAs in class I obesity, whereas head-to-head comparisons with MBS are limited. At current pricing, GLP-1 RAs rarely meet accepted cost-effectiveness thresholds. MBS is the most cost-effective intervention for moderate-to-severe obesity globally, while ESG is promising in lower body mass index groups. Despite their efficacy, GLP-1 RAs are limited by cost. As ESG is not yet available in Korea and evidence supporting MBS in class I obesity continues to accumulate, reassessment of cost-effectiveness in the Korean context is warranted.