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Comparative Study
. 2025 May;31(5):441-450.
doi: 10.18553/jmcp.2025.31.5.441.

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

Ligang Liu  1 , Jiayu Cui  2 , Marjorie V Neidecker  3 , Milap C Nahata  1   4
Affiliations
Comparative Study

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

Ligang Liu et al. J Manag Care Spec Pharm. 2025 May.

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.

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Figures

FIGURE 1
FIGURE 1
Decision Tree Model for the Short-Term Cost-Effectiveness of Tirzepatide Injection vs Semaglutide Tablet vs Semaglutide Injection vs Liraglutide Injection
FIGURE 2
FIGURE 2
Tornado Diagram of One-Way Sensitivity Analysis for Tirzepatide Injection vs Semaglutide Tablet for 68 Weeks
FIGURE 3
FIGURE 3
CE Acceptability Curves From Probability Sensitivity Analyses Results for 68 Weeks
See this image and copyright information in PMC

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