Distributional Cost-Effectiveness Analysis of GlucagonLike Peptide-1 Receptor Agonists (GLP-1 RA) and Tirzepatide Compared with Sulfonylureas (SU) in People with Inadequately Controlled Type 2 Diabetes (T2D)

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. Disclosure 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. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK133465)