Navneet Upadhyay, Ali Bonakdar, Keshab Subedi, Soutrik Banerjee, Benjamin Behrend, Emily R Hankosky
Monthly cost offsets for persistent tirzepatide users versus untreated individuals grew over time, offsetting $319 (ranging from $94 to $544) tirzepatide costs by 12-18 months. These results have implications for the $195 monthly net Medicare cost for the Bridge programme, suggesting tirzepatide may generate near-term cost savings in an older population that stays on treatment.
AIMS: Compare healthcare cost trends among older adults with obesity or overweight treated with tirzepatide versus no treatment.
MATERIALS AND METHODS: Retrospective cohort study using real-world data from US Komodo Research Dataset, 8 November 2022 to 30 September 2025. Adults > 55 years with obesity, or overweight with ≥ 1 weight-related comorbidity, without T2 diabetes who initiated tirzepatide for weight management were compared with propensity score-matched individuals who did not receive any incretin-based therapies. Changes in all-cause healthcare costs (excluding tirzepatide; per-person-per-month) between cohorts were assessed at 3-6, 6-12 and 12-18 months using a difference in differences (DiD) framework. Informative censoring and differential follow-up were addressed with inverse-probability-of-censoring-weights and pairwise censoring.
RESULTS: Each cohort comprised 15843 individuals. Healthcare cost DiD estimates (95% CI) for the tirzepatide versus control cohorts were -$145 (-266, -25; 12.3% reduction; p = 0.022) during 6-12 months and -$319 (-544, -94; 25.4% reduction; p = 0.015) during 12-18 months; using pairwise censoring, estimates were -$181 (-319, -43; p = 0.021) and -$607 (-1007, -207; p = 0.023), respectively. Cost offsets with tirzepatide were driven by higher medical costs in controls during 12-18 months (-$211 [-$407, -$15]; p = 0.065) and fewer inpatient/emergency department visits with tirzepatide versus controls; incidence rate ratio (95% CI) 0.69 (0.50, 0.94; p = 0.021) during 12-18 months.
CONCLUSIONS: Monthly cost offsets for persistent tirzepatide users versus untreated individuals grew over time, offsetting $319 (ranging from $94 to $544) tirzepatide costs by 12-18 months. These results have implications for the $195 monthly net Medicare cost for the Bridge programme, suggesting tirzepatide may generate near-term cost savings in an older population that stays on treatment.