University of Nebraska Medical Center, Department of Pharmacy Practice and Science, College of Pharmacy, Omaha.
J Manag Care Spec Pharm. 2023 Mar;29(3):276-284. doi: 10.18553/jmcp.2023.29.3.276.
Tirzepatide is a novel once-a-week dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist that is used as an addition to diet and exercise to improve blood glucose in adults with type 2 diabetes. It is the first dual glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide receptor agonist that has been approved by the US Food and Drug Administration. The SURPASS-2 clinical trial demonstrated superiority of tirzepatide 10 mg and 15 mg over semaglutide 1 mg in glycated hemoglobin A1c reduction and weight loss from baseline to week 40. Economic analyses to support coverage and access decision-making for tirzepatide are limited. To evaluate the cost-effectiveness of tirzepatide 10 mg vs semaglutide 1 mg injection over 52 weeks of treatment regarding A1c reduction and weight loss from the perspective of the US health care payer. A decision tree model over a 52-week time horizon was developed to identify incremental treatment-related costs of once-weekly tirzepatide 10 mg vs semaglutide 1 mg injection. Costs were divided by mean reduction in A1c and change in body weight from baseline to week 52 observed in the SURPASS-2 clinical trial. In addition to efficacy, probabilities of adverse events, discontinuation, and need for rescue therapy were derived from the SURPASS-2 study. Drug costs in 2022 US dollars were based on wholesale acquisition cost. Costs associated with adverse events were sourced from the published literature. One-way sensitivity analyses were conducted. Treatment with once-weekly tirzepatide 10 mg injection was associated with a higher cost and larger reduction in A1c and body weight after 52 weeks, compared with once-weekly semaglutide 1 mg injection. The incremental cost-effectiveness ratio for tirzepatide vs semaglutide was $2,247 per 1% reduction in A1c and $237 per 1 kg weight loss. One-way sensitivity analysis suggested that incremental cost-effectiveness ratios were most sensitive to the drug costs and treatment effect on A1c and weight. Once-weekly tirzepatide 10 mg was associated with higher cost and greater reduction in A1c and weight vs semaglutide. Tirzepatide 10 mg is cost-effective compared with semaglutide 1 mg if payers' willingness-to-pay threshold exceeds $2,247 for 1% reduction in A1c level and $237 for 1 kg weight loss.
替尔泊肽是一种新型每周一次的双重葡萄糖依赖性胰岛素促分泌多肽和胰高血糖素样肽-1 受体激动剂，可与饮食和运动联合使用，改善 2 型糖尿病成人的血糖。它是第一个获得美国食品和药物管理局批准的双重胰高血糖素样肽-1 和葡萄糖依赖性胰岛素促分泌多肽受体激动剂。SURPASS-2 临床试验表明，替尔泊肽 10mg 和 15mg 优于司美格鲁肽 1mg，可降低糖化血红蛋白 A1c 并减轻体重，从基线到第 40 周。支持替尔泊肽覆盖范围和获取决策的经济分析有限。 从美国医疗保健支付者的角度评估替尔泊肽 10mg 与司美格鲁肽 1mg 注射剂在 52 周治疗期间在降低糖化血红蛋白 A1c 和减轻体重方面的成本效益。 建立了一个 52 周时间框架的决策树模型，以确定每周一次的替尔泊肽 10mg 与司美格鲁肽 1mg 注射剂相比，单次治疗相关成本的增加。成本除以 SURPASS-2 临床试验中观察到的基线至第 52 周时糖化血红蛋白 A1c 和体重的平均降低。除了疗效外，还从 SURPASS-2 研究中得出了不良事件、停药和需要抢救治疗的概率。2022 年的药物成本以批发收购成本为基础。与不良事件相关的成本来自已发表的文献。进行了单因素敏感性分析。 与每周一次的司美格鲁肽 1mg 注射相比，每周一次的替尔泊肽 10mg 注射治疗 52 周后，A1c 和体重的降低幅度更大，成本也更高。替尔泊肽与司美格鲁肽的增量成本效益比为每降低 1%糖化血红蛋白 A1c 增加 2247 美元，每减轻 1 公斤体重增加 237 美元。单因素敏感性分析表明，增量成本效益比最敏感的因素是药物成本和对 A1c 和体重的治疗效果。 与司美格鲁肽相比，替尔泊肽 10mg 每周一次治疗与更高的成本和更大的 A1c 和体重降低相关。如果支付者的支付意愿阈值超过每降低 1%糖化血红蛋白水平 2247 美元和每减轻 1 公斤体重 237 美元，那么替尔泊肽 10mg 与司美格鲁肽 1mg 相比具有成本效益。
