BACKGROUND: More than 80% of patients with heart failure with preserved ejection fraction (HFpEF) are overweight or obese. However, cost-effective treatments that target both conditions remain limited.
OBJECTIVES: The goal of this study was to evaluate the cost-effectiveness of tirzepatide compared with standard care alone for the management of HFpEF in patients with obesity in the United States.
METHODS: A Markov state-transition model was developed to project clinical and economic outcomes over a 20-year time horizon using data from the SUMMIT (A Study of Tirzepatide [LY3298176] in Participants With Heart Failure With Preserved Ejection Fraction [HFpEF] and Obesity) trial. The model included 3 health states: stable HFpEF, worsening heart failure, and death. Both costs and health outcomes were discounted at an annual rate of 3%. The primary outcome was the incremental cost-effectiveness ratio. Deterministic sensitivity analysis was performed to assess key drivers of cost-effectiveness, and probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations to assess uncertainty in model parameters. Outcomes were expressed as total quality-adjusted life years (QALYs), with the unit of analysis being per individual.
RESULTS: Tirzepatide treatment yielded 7.27 (95% uncertainty interval [UI]: 3.20-13.70) QALYs compared with 6.63 (95% UI: 3.69-11.0) QALYs with standard care. Total lifetime costs were higher with tirzepatide ($131,686 [Q1-Q3: $113,005-$150,445]) vs standard care ($87,082 [Q1-Q3: $70,866-$105,268]). The resulting incremental cost-effectiveness ratio was $70,297 per QALY gained, falling below the commonly accepted United States willingness-to-pay threshold of $100,000 per QALY. Deterministic sensitivity analysis revealed that the model was most sensitive to mortality rates and health state utilities. Probabilistic sensitivity analysis found that tirzepatide was cost-effective in >50% of the simulations.
CONCLUSIONS: Tirzepatide seems to be a cost-effective treatment option for patients with HFpEF and obesity in the United States. However, the modest 51% probability of cost-effectiveness underscores the need for further research and pricing adjustments to improve its economic value.