The cost‐utility and budget impact analyses of Tirzepatide versus once‐weekly Semaglutide as add‐on therapy to metformin in patients with type 2 diabetes mellitus in China

Abstract 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.