Presentation (CTI)

OBJECTIVES: Over 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. To evaluate the cost-effectiveness of tirzepatide compared to 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 trial. The model included three health states: stable HFpEF, worsened 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 (ICER). 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 QALYs, with the unit of analysis being per individual.
RESULTS: Tirzepatide treatment yielded 7.27 [3.20-13.70] QALYs compared to 6.63[3.69-11.0] QALYs with standard care. Total lifetime costs were higher with tirzepatide $131,686 [113,005-150,445] versus standard care $87,082 [70,866-105,268]. The resulting ICER was $70,297 per QALY gained, falling below the commonly accepted United States willingness-to-pay (WTP) 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 demonstrated that tirzepatide was cost-effective in more than 50% of the simulations.
CONCLUSIONS: Tirzepatide appears 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.