By Elaine Chen and Isabella Cueto Dec. 29, 2022
CHRISTINE KAO/STAT
The very term “chronic disease” might imply that little changes — or improves — over time. But there is a lot percolating on the chronic disease front, from the mysterious (long Covid) to well-known problems. For the millions of people in the United States who have one or more chronic conditions, a small scientific stir can lead to a huge impact.
Here are three developments we’re watching in 2023:
Obesity’s new foes
The U.S. has seen a surge in obesity rates in the past two decades, with about 42% of adults now having the condition, according to officials’ latest count. But 2023 could see the start of a new, tumultuous phase in the long struggle against obesity.
Drugmakers are racing to develop novel obesity treatments, and more are set to be available next year. The latest approved drug, Novo Nordisk’s Wegovy, was in shortage this year due to manufacturing issues, but the company this week reported all doses are now available to retail pharmacies nationwide. The FDA late last week approved it for teenagers 12 and older, which is likely to increase demand for the weekly injection even more. Eli Lilly is expecting a decision from regulators next year on whether to approve one of its drugs, tirzepatide, for obesity. Pfizer and Amgen are also testing products.
A big question about these treatments is how accessible they’ll be and how they’ll affect existing health inequities. Many insurers, including Medicare, don’t currently cover weight-loss drugs that can be expensive. Wegovy, for example, costs over $1,300 per month and is taken over the long term, so many patients can’t afford to pay for it out of pocket.
Another question is how much these medications will benefit patients based on health indicators other than weight, such as cardiovascular outcomes.
At last, a long Covid trial
The start of the new year will mark almost three years since Covid-19 broke into the lives of people worldwide and started to leave some of the infected with mysterious, lingering health problems. Not only did people put off routine doctor’s appointments, screenings and vaccinations, but long Covid emerged as an apparently new, chronic condition. An unknown number of people who were healthy before are newly disabled by chronic fatigue, immune dysregulation and others of the over 200 symptoms associated with long Covid.
So far, research into long Covid has been characterized by stagnation and frustration — more questions than answers. Will that change in 2023? RECOVER, the NIH’s $1 billion effort to understand the long-term effects of Covid, expects to initiate a handful of clinical trials in the first half of the new year. But partisan battles over NIH funding could threaten the sustainability of that research in the future.
Still to figure out: Whether people with long Covid have long-term impacts to their health, or their symptoms fade over time. Will some people have decades-long or lifelong health problems? And, in the bigger picture, how does the addition of so many chronically ill people change medicine, the workforce, major sectors of the economy, or the way we view and treat chronic conditions? Will science and society become resigned to long Covid?
For some, long Covid can be fatal, according to a recent report from the National Center for Health Statistics. And, as connections emerge between Covid infection (and, to a lesser degree, vaccination) and other conditions, such as POTS, they raise the likelihood that the long tail of Covid is quite long — and complicated.
The cost of care
Even before historic levels of inflation, health care was unaffordable for a vast swath of the population. In 2023, with the economy standing on the diving board, dialogue around the cost of care for chronic conditions could reach a boiling point.
In particular, eyes are on the Inflation Reduction Act, and its potential impacts on everything from drug research and development (stifling, some drugmakers predict) to the cost of insulin and other prescription drugs (helpful, for some patients).
Tools adapted from the pandemic, such as telehealth services, could help offset some health care costs, and some of the costs to patients (transportation, missed work, child care, parking, etc.) But payers and providers are still figuring out how best to manage hybrid care models, and states are still massaging legislation around telehealth. Next year could largely determine where telehealth fits into health care, and who it serves.
Consider the already-astronomical cost of chronic disease care in the United States: trillions of dollars devoted to diabetes, heart disease, kidney disease, cancer and other conditions, and still so many people unable to access necessary care and treatments. Consider the strain of Covid on the health care system, the decimation of public health staffing, and the scarcity of health care workers — and how all these costs make their way to patients. What bold moves can be made in 2023 to help reduce the cost of care? We’ll see.
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