Background:

Twelve-month IBT persistence in real-world practice commonly falls below 50%. How self-pay vs state-funding may affect IBT persistence has not been fully characterised. Roczen, a digital specialist weight management clinic, manages patients across NHS and self-pay routes using the same specialist clinical workforce and digital infrastructure, partially controlling for the effect of funding on outcomes. This study evaluates IBT persistence, programme retention, and efficacy between self-pay and NHS cohorts up to 48 weeks.
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Methods:

IBT persistence was assessed in a cohort of consecutively enrolled patients reaching 48-week programme maturity (n=180; NHS n=80, self-pay n=100). Retention was defined as active enrolment without formal withdrawal, and IBT persistence as a dispensing record within eight weeks of a 48-week milestone. Efficacy and dosing were assessed in IBT-naive patients reaching 48 weeks (n=153; NHS n=74, self-pay n=79). IBT usage was assigned on the last prescription.
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Results:

The NHS cohort (80.0% female, age 52.9+/-13.8 years) had greater baseline complexity compared to self-pay (67.0% female, age 52.5+/-10.6 years), with significantly higher BMI (46.39+/-9.28 vs 35.57+/-6.8 kg/m2; p<0.001), osteoarthritis (37.5% vs 15.0%; p<0.001), and hypothyroidism (15.0% vs 5.0%; p=0.043); type 2 diabetes prevalence was not significantly different (8.8% vs 10.0%; p=0.977). NHS patients had higher retention (90.0% vs 72.0%; p=0.005) and IBT persistence (83.8% vs 65.0%; p=0.008). Tirzepatide use was greater in the self-pay group (91.7% vs 58.1%; p<0.001), with NHS tirzepatide patients more likely to reach higher doses (>=10mg: 67.4% vs 43.2%; p=0.035). Documented weight loss was greater in self-pay patients at both 24 weeks (-14.6%, n=74 vs -11.6%, n=60; p=0.007) and 48 weeks (-19.3%, n=53 vs -16.7%, n=39; p=0.03).
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Conclusion:

Clinically meaningful weight loss and high IBT persistence were observed for both funding cohorts versus real-world benchmarks, with the NHS cohort achieving greater retention on treatment. Therefore, this high-engagement digital care model, in addition to funding-source, may be a key driver of IBT persistence.