Economic evaluation of tirzepatide, semaglutide, and liraglutide in the treatment of obese and overweight patients without diabetes: a short-term cost-effectiveness analysis in Iran.
Semaglutide is the most cost-effective GLP-1 therapy for obesity treatment in Iran, while tirzepatide, despite offering greater health benefits, is not cost-effective at current prices.
Where it sits
this study against the rest of the liraglutide corpusSummary and findings
This study evaluated the short-term cost-effectiveness of tirzepatide, semaglutide, and liraglutide in treating adults with overweight or obesity without diabetes in Iran over 68 weeks. The analysis found that liraglutide was dominated by semaglutide, which was deemed cost-effective at a threshold of US$15,558.5 per QALY. Tirzepatide offered greater health benefits but was associated with a higher cost of US$34,423.89 per QALY compared to semaglutide.
Abstract
<h4>Purpose</h4>GLP-1 and dual GLP-1/GIP receptor agonists have improved obesity treatment, but their high cost requires economic evaluation to guide resource allocation. To assess the short-term cost-effectiveness of subcutaneous tirzepatide, semaglutide, and liraglutide for treating adults with overweight or obesity without diabetes in Iran.<h4>Methods</h4>A decision-tree model was developed to compare tirzepatide, semaglutide, and liraglutide over 68 weeks in adults aged ≥ 18 years with BMI ≥ 30 kg/m² or ≥ 27 kg/m² with at least one additional weight-related complication, excluding those with diabetes, from the payer perspective. Clinical effectiveness, adverse event (AE), and treatment discontinuation data were obtained from published literatures. Quality-adjusted life years (QALYs) were estimated based on BMI changes and AE-related disutility. Direct medical costs included drug acquisition and AE management costs. Deterministic and probabilistic sensitivity analyses were performed.<h4>Results</h4>Compared with semaglutide, tirzepatide generated greater health benefits but at higher costs, resulting in an incremental cost-effectiveness ratio of US$34,423.89/QALY. Liraglutide was dominated by semaglutide. Semaglutide was cost-effective at the Iranian willingness-to-pay threshold of US$ (Purchasing power parity (PPP) 15,558.5/QALY, equal to one time GDP per capita in 2026. Sensitivity analyses confirmed the robustness of the findings.<h4>Conclusion</h4>Semaglutide was the cost-effective injectable GLP-1-based therapy in Iran. Although tirzepatide provided greater health benefits, its higher cost limited its cost-effectiveness at current prices.<h4>Supplementary information</h4>The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02114-z.
Background
This paper addresses the economic evaluation of GLP-1 and dual GLP-1/GIP receptor agonists for obesity treatment, focusing on the cost-effectiveness of these therapies in Iran. Prior studies have shown the effectiveness of these agents in managing obesity, but their high costs necessitate an economic analysis to inform resource allocation. Understanding the cost-effectiveness of these treatments is crucial for healthcare decision-makers, especially in resource-limited settings.
Methods
A decision-tree model was developed to compare tirzepatide, semaglutide, and liraglutide over 68 weeks in adults aged ≥18 years with BMI ≥30 kg/m² or ≥27 kg/m² with at least one additional weight-related complication, excluding those with diabetes. The study evaluated clinical effectiveness, adverse events, and treatment discontinuation data sourced from published literature. Quality-adjusted life years (QALYs) were estimated based on BMI changes and adverse event-related disutility.
Results
The primary finding indicated that tirzepatide generated greater health benefits compared to semaglutide but at a higher cost, resulting in an incremental cost-effectiveness ratio of US$34,423.89 per QALY. Liraglutide was found to be dominated by semaglutide, which was deemed cost-effective at the Iranian willingness-to-pay threshold of US$15,558.5 per QALY. Sensitivity analyses confirmed the robustness of these findings.
Interpretation
The results suggest that while tirzepatide may offer greater health benefits, its higher cost limits its cost-effectiveness compared to semaglutide. This aligns with previous literature indicating that semaglutide is a more economically viable option for obesity management in similar populations. However, the reliance on published literature for clinical data and the use of a decision-tree model may limit the generalizability of these findings to real-world settings.
Key findings
- Incremental cost-effectiveness ratio of US$34,423.89/QALY for tirzepatide compared to semaglutide.
- Liraglutide was dominated by semaglutide.
- Semaglutide was cost-effective at the Iranian willingness-to-pay threshold of US$15,558.5/QALY.
Limitations
- Relies on published literature for clinical effectiveness and adverse events.
- Decision-tree model may not capture long-term effects.
- Short-term analysis may not reflect durability of outcomes.