ZHANG Jing, LIU Guo-qiang, GAO Sheng-nan, GAO Ning, ZHANG Yu-xi, XIE Hao
Objective: To evaluate the economy of different doses of tirzepatide and semaglutide in the treatment of adult patients with type 2 diabetes mellitus (T2DM) in China, thus to provide a reference for medical insurance decision-making. Methods: The Markov model was adopted to simulate the long-term health outputs and economic benefits of the four treatment regimens. Taking quality-adjusted life years (QALYs) as the indicator of health output and three times China's per capita GDP in 2024 as the willingness to pay threshold (WTP), the health output and medical costs of patients after 30 years of treatment with four treatment regimens were simulated. The incremental cost-effectiveness ratio (ICER) was used as the evaluation index to evaluate the economy of the four treatment regimens. The key assumptions were verified through univariate and probabilistic sensitivity analyses to ensure the robustness of the model. Results: Compared with the 1 mg semaglutide treatment regimen, the incremental costs of the 5, 10, 15 mg tirzepatide treatment regimens were 333 108.30, 699 163.50, 968 283.70 yuan, respectively; the incremental effects were 0.063 1, 0.140 5, and 0.165 5 QALYs respectively; the ICERs were 5 278 151.00, 4 977 303.00, and 5 852 089.70 yuan·QALY-1, respectively. When the WTP was 287 247 yuan·QALY－1, the 5, 10, 15 mg tirzepatide treatment regimens were not economically viable. The results of the sensitivity analysis showed that the results of the basic analysis were relatively robust. The results of the situation analysis showed that at the WTP of 287 247 yuan·QALY－1, when the unit prices of 5, 10, 15 mg tirzepatide decrease by 68.4%, 79.6%, and 77.3% respectively, the probabilities of economic viability of tirzepatide compared with semaglutide were comparable. Conclusion: For T2DM patients with poor blood glucose control treated with metformin monotherapy, compared with the 1 mg semaglutide regimen, the 5, 10, 15 mg tirzepatide treatment regimens have a lower probability of being economically viable at the current price. Appropriate price reduction can make tirzepatide become a safer, more effective, and economical treatment regimen.
