Liu Ligang, Cui Jiayu, Neidecker Marjorie V, Nahata Milap C
Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus.
CVS Health, Woonsocket, RI.
J Manag Care Spec Pharm. 2025 May;31(5):441-450. doi: 10.18553/jmcp.2025.31.5.441.
Glucagon-like peptide-1 receptor agonists and their analogues have emerged as effective pharmacotherapies for obesity.
To assess the short-term cost-effectiveness of subcutaneous tirzepatide, semaglutide, liraglutide, and oral semaglutide for managing obesity or overweight in patients without diabetes.
A decision tree model was developed using a 68-week time window with consideration of serious adverse events and treatment discontinuation from a US payer's perspective. The study population were adults with obesity or overweight with at least 1 weight-related comorbidity but without diabetes. Clinical data were obtained from clinical trials. Model utilities, disutilities, and the costs of serious adverse events were sourced from published literature. Medication costs were assigned from Red Book. All costs were calculated in 2024 US dollars. The incremental cost-effectiveness ratio was calculated based on the cost per quality-adjusted life-year (QALY) gained. A willingness-to-pay threshold of $150,000 per QALY was used. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the effect of parameter uncertainty on the results.
In the base-case analysis, both subcutaneous tirzepatide and oral semaglutide were cost-effective vs subcutaneous liraglutide and subcutaneous semaglutide. Compared with oral semaglutide, subcutaneous tirzepatide was cost-effective, with an incremental cost-effectiveness ratio of $34,212 per QALY gained. Sensitivity analyses indicated the results were highly sensitive to medication costs and the effectiveness of medications. The probabilistic sensitivity analysis suggested that subcutaneous tirzepatide was most likely to remain cost-effective, with a 98% probability at a willingness to pay of $150,000 per QALY compared with other medications.
Subcutaneous tirzepatide and oral semaglutide were cost-effective therapies compared with subcutaneous liraglutide and subcutaneous semaglutide for the short-term management of obesity in adults without diabetes. At or under a willingness-to-pay threshold of $150,000 per QALY, subcutaneous tirzepatide was most cost-effective, surpassing oral semaglutide. These findings provide valuable insights for health care decision-makers in selecting antiobesity medications.
胰高血糖素样肽-1受体激动剂及其类似物已成为治疗肥胖的有效药物疗法。
评估皮下注射替尔泊肽、司美格鲁肽、利拉鲁肽以及口服司美格鲁肽用于治疗无糖尿病患者的肥胖或超重的短期成本效益。
采用决策树模型，时间窗为68周，从美国医保支付方的角度考虑严重不良事件和治疗中断情况。研究人群为患有肥胖或超重且至少有一种与体重相关合并症但无糖尿病的成年人。临床数据来自临床试验。模型效用、负效用以及严重不良事件的成本均来自已发表的文献。药物成本根据《红皮书》确定。所有成本均以2024年美元计算。基于每获得一个质量调整生命年（QALY）的成本计算增量成本效益比。采用每QALY 150,000美元的支付意愿阈值。进行单向敏感性分析和概率敏感性分析，以评估参数不确定性对结果的影响。
在基础病例分析中，皮下注射替尔泊肽和口服司美格鲁肽相对于皮下注射利拉鲁肽和皮下注射司美格鲁肽具有成本效益。与口服司美格鲁肽相比，皮下注射替尔泊肽具有成本效益，每获得一个QALY的增量成本效益比为34,212美元。敏感性分析表明，结果对药物成本和药物有效性高度敏感。概率敏感性分析表明，皮下注射替尔泊肽最有可能保持成本效益，在每QALY支付意愿为150,000美元时，与其他药物相比，其具有成本效益的概率为98%。
与皮下注射利拉鲁肽和皮下注射司美格鲁肽相比，皮下注射替尔泊肽和口服司美格鲁肽是治疗无糖尿病成年人肥胖的短期成本效益疗法。在每QALY支付意愿阈值为150,000美元及以下时，皮下注射替尔泊肽最具成本效益，超过口服司美格鲁肽。这些发现为医疗保健决策者选择抗肥胖药物提供了有价值的见解。
