Assessing the Value: Tirzepatide vs. Semaglutide in Obesity and Osteoarthritis

The ongoing challenge in managing obesity and osteoarthritis lies in balancing clinical effectiveness with economic viability. Incretin-based therapies, including semaglutide and the dual GIP/GLP-1 agonist tirzepatide, are emerging at the forefront of this therapeutic crossroad.

A microsimulation model indicated that, under that model’s assumptions, tirzepatide may be more cost-effective than semaglutide for adults with knee osteoarthritis and obesity.

Cost-effectiveness is model-dependent and can vary by perspective, willingness-to-pay threshold, and time horizon, so such findings should be interpreted within those parameters rather than as universal conclusions.

These model-derived cost-effectiveness signals may inform payer formulary tiers or step-therapy policies and guide how clinicians prioritize therapies for adults with knee osteoarthritis and obesity.

These economic and clinical considerations matter, but here “traditional obesity management” refers largely to lifestyle therapy with or without older agents such as orlistat; some recent obesity guidelines also include incretin-based therapies among pharmacologic options, without making osteoarthritis-specific endorsements.

The economic implications of tirzepatide should not be underestimated; while promising, economic value is sensitive to drug pricing, coverage policies, real-world adherence, and tolerability.

For patients with osteoarthritis, reduced patient costs can translate to improved access and experience, but coverage criteria, step-therapy requirements, and supply constraints may limit those gains.

Even if models suggest advantages for some incretin therapies, real-world choices vary with coverage criteria, patient characteristics, and side-effect profiles, underscoring the need for strategic selection in pharmacotherapy.

Advances in incretin-based therapies (GLP-1 receptor agonists and dual GIP/GLP-1 agonists such as tirzepatide) offer emerging opportunities that may enhance patient outcomes, reflecting strides in pharmacoeconomic efficiency. Translating these insights into practice still requires navigating prior authorization and step-therapy policies, aligning clinic workflows for monitoring and dose titration, and supporting patient adherence.

Key Takeaways:

• Model-based analyses suggest tirzepatide may be more cost-effective than semaglutide for adults with knee osteoarthritis and obesity, but results depend on perspective, thresholds commonly used in the U.S., and time horizon.
• Incretin-based therapies are increasingly included among pharmacologic options in recent obesity guidance, while traditional management centers on lifestyle therapy with or without older agents such as orlistat.
• Implementation hinges on payer coverage (including prior authorization and step therapy), clinic capacity for monitoring, and patient adherence support.