Real-world treatment patterns and cost per patient achieving treatment targets among tirzepatide and semaglutide initiators in US patients with type 2 diabetes

BACKGROUND: Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist (RA), and semaglutide, a GLP-1 RA, are approved for type 2 diabetes (T2D) management. Clinical trials demonstrated that tirzepatide provided greater hemoglobin A1c and weight reduction vs comparators. Studies using trial-based effect estimates indicate it may also offer a lower cost per patient achieving treatment targets. However, real-world comparative data on treatment patterns, effectiveness, and economic value are limited. OBJECTIVE: To compare real-world treatment patterns, A1c and weight outcomes, and type 2 diabetes-related pharmacy (T2D-Rx) costs per patient achieving treatment targets in patients initiating tirzepatide for T2D, stratified by prior GLP-1 RA use. METHODS: This retrospective cohort study used claims and laboratory data from the Healthcare Integrated Research Database. Adults with T2D initiating tirzepatide (Mounjaro only) or semaglutide (Ozempic only) from May 2022 to May 2023 were propensity score matched and classified as naive or non-naive based on GLP-1 RA exposure in the 6 months before initiation. Outcomes over 12 months of follow-up included adherence (proportion of days covered ≥0.80), persistence (no ≥45-day gap), and T2D-Rx cost per responder (mean T2D-related pharmacy cost ÷ proportion achieving treatment target) to achieve A1c (<8%, <7%, ≤6.5%, <5.7%) and weight loss (≥5%, ≥10%, ≥15%) thresholds. Outcomes were compared using chi-square and t-tests. RESULTS: After matching, 10,702 naive and 5,577 non-naive patient pairs were included in each treatment group. Tirzepatide initiators demonstrated higher adherence (naive: 60% vs 45%; non-naive: 66% vs 48%) and persistence (naive: 62% vs 47%; non-naive: 68% vs 49%) than semaglutide initiators. A greater proportion of tirzepatide users achieved all A1c and weight outcomes, including the most stringent targets of A1c less than 5.7% (naive: 30% vs 18%; non-naive: 17% vs 6%) and weight loss greater than or equal to 15% (naive: 23% vs 10%; non-naive: 17% vs 5%). Tirzepatide also had lower T2D-Rx cost per responder for these most stringent endpoints: A1c less than 5.7% (naive: $45,300 vs $65,300; non-naive: $107,700 vs $270,300) and weight loss greater than or equal to 15% (naive: $62,900 vs $124,400; non-naive: $110,200 vs $326,800), as well as for most other weight loss thresholds. For less stringent A1c goals, T2D-Rx cost per responder was similar across tirzepatide and semaglutide. CONCLUSIONS: In this real-world analysis, tirzepatide demonstrated better adherence, persistence, and A1c and weight reductions and lower T2D-Rx cost per responder for the most stringent treatment targets than semaglutide in both GLP-1 RA-naive and non-naive patients with T2D. These findings support the clinical and economic value of tirzepatide for achieving meaningful treatment outcomes in real-world patient populations.