Distribution of access to obesity pharmacotherapy
How is access to incretin-based obesity pharmacotherapy distributed, and what does the pattern of unregulated supply indicate about it?
§1Abstract
§1.1Review question
How is access to incretin-based obesity pharmacotherapy distributed, and what does the pattern of unregulated supply indicate about it?
§1.2PICO frame
Table 1. The registered PICO frame. Any change made after protocol registration is recorded in the amendment log at §5 and is identified there as post hoc.
| Element | As registered |
|---|---|
| Population | Adults meeting the eligibility criteria of the pivotal trials. |
| Intervention | Access to an approved presentation. |
| Comparator | No access, or access through an unregulated channel. |
| Outcomes | Treatment initiation; persistence; the composition of unregulated demand. |
§1.3Method in brief
A review whose unit of analysis is a study characteristic rather than a treatment effect. The protocol was registered with the Institute's secretariat before the search was executed. The search was run on 11 September 2024 across 8 sources and is reproduced in full at §2. Screening, extraction and certainty assessment were performed independently by two members of the secretariat with disagreement resolved by a third.
§1.4Conclusion
Low certainty evidence indicates that eligibility under the pivotal trial criteria substantially exceeds treated prevalence in every jurisdiction for which the Institute could obtain data, and that unregulated supply is concentrated in exactly the compounds whose approved presentations are supply-constrained or not reimbursed. The Institute records this as context rather than as a finding about any compound, and states plainly that it does not follow from an access gap that unregulated supply is a reasonable substitute; the quality evidence in this document set indicates the opposite.
The conclusion rests on 24 contributing studies, listed with their extracted data at §3 and summarised outcome by outcome at §4.