We assessed the cost-effectiveness of GLP-1 RA and tirzepatide compared with SU when added to metformin in people with inadequately controlled T2D. Using data from the National Health and Nutrition Examination Survey (2013-2018), we constructed a nationally representative T2D sample poorly controlled on metformin (A1c> 7.0%). We used the BRAVO diabetes model, a validated microsimulation model, to predict individuals’ lifetime health and economic outcomes based on their current health profile and received treatment (GLP-1 RA, tirzepatide, or SU). We identified factors driving the cost-effectiveness and developed a scoring algorithm using these variables, with higher scores indicating more cost-effective. Under a willingness to pay threshold of $100,000/QALY, GLP-1 RA ($92,590/QALY) and tirzepatide (5 mg: $70,540/QALY, 10 mg: $60,700/QALY, 15 mg: $55,600//QALY) were all cost-effective compared with SU. The cost-effectiveness drivers included age, gender, smoking, diabetes duration, A1c, SBP, and cardiovascular disease history (Figure). Our scoring algorithm can stratify patients by the cost-effectiveness of using GLP-1 RA or tirzepatide, which can be used to design precision interventions to improve drug use targeting patients for whom the drug use can be cost-effective.


P.Li: None. A.G.Winterstein: Consultant; Bayer Inc., Genentech, Inc., Ipsen Biopharmaceuticals, Inc., Research Support; Merck Sharp & Dohme Corp. J.Guo: Consultant; Pfizer Inc., Research Support; PhRMA Foundation, NIH - National Institutes of Health. H.Shao: Consultant; Lilly Diabetes. D.Guan: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. K.Narayan: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. L.Shi: None. J.Bian: None. Y.Guo: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.