GLP-1 receptor agonist utilization in Croatia climbed from near zero at market entry to 15.99 defined daily doses per 1000 inhabitants per day by 2024, representing 16.1% of all non-insulin antidiabetic prescriptions. More strikingly, GLP-1 RAs now consume 42.7% of total non-insulin antidiabetic expenditure — €42.07 million in 2024 alone — with semaglutide as the dominant agent by both volume and cost, ahead of dulaglutide and liraglutide. Obesity-specific prescribing remained substantially underutilized due to absent reimbursement coverage.
This Croatian pharmacoepidemiological snapshot mirrors a pattern playing out across European healthcare systems: rapid clinical adoption of GLP-1 RAs for type 2 diabetes, where reimbursement pathways exist, running well ahead of coverage for obesity indications despite equivalent or stronger evidence bases for cardiometabolic benefit in that population. The cardiovascular outcome data from LEADER, SUSTAIN-6, and SELECT trials make the obesity reimbursement gap increasingly difficult to justify on clinical grounds. The finding that 42.7% of drug spending is concentrated in a class covering only 16.1% of prescriptions underscores the profound budget pressure these agents create for single-payer systems. This is a well-conducted retrospective database study — descriptive rather than causal — and Croatia's specific reimbursement architecture limits direct generalizability. Still, its value lies in quantifying how policy inertia on obesity indications persists even as clinical evidence matures, an increasingly urgent tension for health-system planners across Europe.