A Cost-Benefit Framework for Providing GLP-1 Medications to US Military Personnel

Abstract

The increasing prevalence of obesity among active-duty service members poses significant readiness and personnel management challenges for the Department of Defense (DoD). Under current policies, weight-related separations generate substantial recruitment, training, and replacement costs while reducing operational readiness. Recent advancements in weight-management medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists, present a potential alternative to separation-based approaches by assisting service members in managing obesity and improving health outcomes. However, the fiscal and readiness implications of expanding access to these medications within the Military Health System (MHS) have not been systematically evaluated. This study develops a structured cost-benefit analysis (CBA) framework using federal regulatory guidance from the Office of Management and Budget (OMB) Circulars A-4 and A-94. The framework evaluates expanded access to GLP-1 therapy among clinically eligible active-duty personnel by defining baseline conditions, identifying marginal program costs, and estimating potential benefits. A net present value (NPV) decision rule is applied to assess whether medication-based intervention represents a cost-effective alternative to the current separation-based policy.