U.S. Payers May Find Tirzepatide Costs Acceptable Given the Treatment Benefits in Patients with Type 2 Diabetes


Tirzepatide was associated with a greater reduction in hemoglobin A1c and body weight versus semaglutide. Though, with a current list price of $1,023 for a one-month supply of tirzepatide (Mounjaro; Lilly), is it worth it?

Tirzepatide costs $2,247 more than semaglutide to achieve an extra 1% reduction in hemoglobin A1c (a measure of average blood sugar level) and $237 more than semaglutide for an extra 1 kilogram (about 2.2 pounds) in weight loss, according to a new study published in the Journal of Managed Care + Specialty Pharmacy.

The effectiveness of tirzepatide in A1C and weight reduction was previously confirmed through the SURPASS trials, which compared tirzepatide to placebo and standard of care options such as semaglutide. In these trials, once-weekly tirzepatide was associated with a greater reduction in A1c and body weight versus semaglutide. But, with a current list price of $1,023 for a one-month supply of tirzepatide (Mounjaro; Lilly), is it worth it?

Researchers from the University of Nebraska College of Pharmacy sought to determine the economic value of tirzepatide. However, “There is no recognized threshold of cost-effectiveness for change in A1c and weight in patients with type 2 diabetes,” Professor Carrie McAdam-Marx, PhD, corresponding author of the study, explained to Formulary Watch.

As such, value could not be readily assigned to the health benefits tirzepatide provides, limiting the potential to draw an economic conclusion from the SURPASS trials.

To investigate, researchers used data from the SURPASS trials in a new analysis and developed a decision tree model to explore the relative cost-effectiveness of tirzepatide versus semaglutide over a 52-week period. Their model considered adverse events, treatment discontinuation, hyperglycemia rescue therapy, weight loss, and A1c reduction. They estimated treatment-related costs from a US payer’s perspective. The researchers reported one-month supply costs as $974 for tirzepatide vs $892 for semaglutide, based on wholesale acquisition costs as of the time of their analysis.

The researchers found that total costs were higher in those treated with tirzepatide as opposed to semaglutide. However, tirzepatide treatment was also associated with greater reductions in both A1c and weight. Next, the team identified incremental cost ratios, or the cost associated with a 1% decrease in A1c or a 1-kg reduction in weight.

They determined that tirzepatide 10 mg costs $2,247 more than semaglutide 1 mg per 1% reduction in A1c, and $237 more per 1 kg loss in weight.

While tirzepatide is more costly, Professor McAdam-Marx recognizes the potential value it provides. “The incremental cost of tirzepatide for a 1% reduction in A1c and for 1 kg weight loss represents good economic value in the short term compared with semaglutide in overweight/obese patients with type 2 diabetes, given the costs associated with managing these conditions and their complications,” she said.

Tirzepatide is an injectable glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist. The FDA approved Mounjaro in May 2022 to improve glycemic control in adults with type 2 diabetes, along with diet and exercise. In October, the FDA granted fast-track designation to Mounjaro, accelerating the drug’s path toward approval for weight loss.

Semaglutide is a GLP-1 receptor agonist. Branded as Ozempic (Novo Nordisk), the drug is indicated for type 2 diabetes as well as reducing cardiovascular risk in adults with type 2 diabetes and heart disease; semaglutide is also indicated for weight loss as the brand Wegovy (also Novo Nordisk).

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