Tirzepatide vs semaglutide and liraglutide for weight loss in patients with overweight or obesity without diabetes: A short-term cost-effectiveness analysis in the United States.

IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Ligang Liu, Jiayu Cui, Marjorie V Neidecker, Milap C Nahata
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Abstract

Background: Glucagon-like peptide-1 receptor agonists and their analogues have emerged as effective pharmacotherapies for obesity.

Objective: To assess the short-term cost-effectiveness of subcutaneous tirzepatide, semaglutide, liraglutide, and oral semaglutide for managing obesity or overweight in patients without diabetes.

Methods: 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.

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.

Conclusions: 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.

替西帕肽vs西马鲁肽和利拉鲁肽用于超重或肥胖无糖尿病患者的减肥:美国的短期成本-效果分析
背景: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。目的:评估皮下替西帕肽、西马鲁肽、利拉鲁肽和口服西马鲁肽治疗非糖尿病患者肥胖或超重的短期成本效益。方法:从美国付款人的角度考虑严重不良事件和停止治疗,采用68周的时间窗建立决策树模型。研究人群是肥胖或超重的成年人,至少有一种体重相关的合并症,但没有糖尿病。临床资料来源于临床试验。模型效用、非效用和严重不良事件的成本来源于已发表的文献。药物费用从红皮书中分配。所有费用均按2024美元计算。增量成本-效果比是根据获得的每个质量调整生命年(QALY)的成本计算的。每个QALY的支付意愿阈值为150,000美元。采用单因素敏感性分析和概率敏感性分析评价参数不确定性对结果的影响。结果:在基本病例分析中,皮下注射替西帕肽和口服西马鲁肽比皮下注射利拉鲁肽和皮下注射西马鲁肽具有成本效益。与口服西马鲁肽相比,皮下替西帕肽具有成本效益,每获得QALY的增量成本-效果比为34,212美元。敏感性分析表明,结果对药物费用和药物有效性高度敏感。概率敏感性分析表明,与其他药物相比,皮下替西帕肽最有可能保持成本效益,每个QALY愿意支付150,000美元的概率为98%。结论:与利拉鲁肽和西马鲁肽相比,皮下替西帕肽和口服西马鲁肽在短期治疗无糖尿病成人肥胖方面具有成本效益。在每个QALY的支付意愿阈值为150,000美元或低于150,000美元时,皮下替西帕肽的成本效益最高,超过口服西马鲁肽。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。
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来源期刊
Journal of managed care & specialty pharmacy
Journal of managed care & specialty pharmacy Health Professions-Pharmacy
CiteScore
3.50
自引率
4.80%
发文量
131
期刊介绍: JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.
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