Heart failure with preserved ejection fraction (HFpEF) associated with obesity is increasingly common and contributes to substantial symptom burden and healthcare utilization. Although tirzepatide improved symptoms and clinical outcomes in the SUMMIT trial population, questions remain regarding its economic value in routine care. A health economic analysis published in the International Journal of Cardiology evaluated the cost-effectiveness and budget impact of tirzepatide for HFpEF with obesity from the perspective of the German statutory health insurance system.

The analysis used a Markov model comparing tirzepatide plus standard care versus placebo plus standard care over a 5-year horizon. Monthly transitions across 4 Kansas City Cardiomyopathy Questionnaire clinical summary score-defined health states and death were modeled using SUMMIT trial data. Deterministic and probabilistic sensitivity analyses, including price-reduction scenarios, were also performed.

Findings

• Discounted per-patient costs were estimated at €31,052 with tirzepatide compared with €5,827 with placebo-based care.
• Tirzepatide was associated with 3.638 quality-adjusted life years (QALYs) versus 3.539 QALYs with placebo.
• The treatment generated an additional 0.100 QALYs at an incremental cost of €25,225.
• The incremental cost-effectiveness ratio was estimated at €252,611 per QALY gained, with a low probability of cost-effectiveness at a willingness-to-pay threshold of €100,000/QALY.
• Five-year incremental healthcare spending was projected at approximately €1.9-6.2 billion under SUMMIT-like eligibility criteria and €3.8-12.6 billion with broader eligibility, depending on treatment uptake.

Tirzepatide provided modest gains in quality-adjusted survival but at substantially higher healthcare costs in HFpEF with obesity. The analysis suggested that current pricing limits both cost-effectiveness and affordability at scale within the German healthcare system.