AIM: To evaluate the long-term economic implications and potential budgetary consequences for the national health insurance system (NHIS) of tirzepatide versus semaglutide as add-on therapy to metformin in patients with type 2 diabetes mellitus (T2DM) in China.
METHODS: The demographic and clinical efficacy data were derived from the SURPASS-2 trial. The cost-utility analysis was performed to estimate the cost-utility by UK Prospective Diabetes Study Outcomes Model Version 2.2 from the Chinese health care providers' perspective, incorporating costs and quality-adjusted life years (QALYs). Sensitivity analyses were employed to investigate the presence of uncertainty. The financial implications for the relevant budgetary authority over 5 years were estimated.
RESULTS: In the long-term treatment simulation, tirzepatide 5 and 10 mg yielded incremental QALYs of 0.05 and 0.09, in comparison with semaglutide 1 mg, respectively. The associated incremental costs for these treatments were $23 563.42 and $47 583.74, respectively. Consequently, the incremental cost-utility ratios were calculated to be $445 125.24/QALY and $543 829.19/QALY, both of which exceeded the established threshold of $29 599.90/QALY. These base-case results were validated through robust sensitivity analyses. The budget impact analysis showed that such an expansion would incur an additional budgetary burden of approximately $80 million to $490 million for the NHIS over a simulated 5-year period.
CONCLUSION: This dual analysis provides policymakers and payers with a comprehensive basis for decision-making. Tirzepatide offered substantial long-term health benefits, but they were not cost-effective compared with semaglutide 1 mg in T2DM patients inadequately controlled with metformin under China's health care providers' perspective. The entry of tirzepatide 5 mg into the NHIS may increase the financial burden of national medical insurance, but overall health care expenditures are expected to decrease, driven primarily by significantly reduced out-of-pocket expenses for patients.
