Journal of Diabetes and Metabolic Disorders · Oct 17, 2026

Economic evaluation of tirzepatide, semaglutide, and liraglutide in the treatment of obese and overweight patients without diabetes: a short-term cost-effectiveness analysis in Iran

By Reiszadeh N, Radmanesh R, Heshmat R et al.

PURPOSE: GLP-1 and dual GLP-1/GIP receptor agonists have improved obesity treatment, but their high cost requires economic evaluation to guide resource allocation. To assess the short-term cost-effectiveness of subcutaneous tirzepatide, semaglutide, and liraglutide for treating adults with overweight or obesity without diabetes in Iran. METHODS: A decision-tree model was developed to compare tirzepatide, semaglutide, and liraglutide over 68 weeks in adults aged ≥ 18 years with BMI ≥ 30 kg/m² or ≥ 27 kg/m² with at least one additional weight-related complication, excluding those with diabetes, from the payer perspective. Clinical effectiveness, adverse event (AE), and treatment discontinuation data were obtained from published literatures. Quality-adjusted life years (QALYs) were estimated based on BMI changes and AE-related disutility. Direct medical costs included drug acquisition and AE management costs. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Compared with semaglutide, tirzepatide generated greater health benefits but at higher costs, resulting in an incremental cost-effectiveness ratio of US$34,423.89/QALY. Liraglutide was dominated by semaglutide. Semaglutide was cost-effective at the Iranian willingness-to-pay threshold of US$ (Purchasing power parity (PPP) 15,558.5/QALY, equal to one time GDP per capita in 2026. Sensitivity analyses confirmed the robustness of the findings. CONCLUSION: Semaglutide was the cost-effective injectable GLP-1-based therapy in Iran. Although tirzepatide provided greater health benefits, its higher cost limited its cost-effectiveness at current prices. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02114-z.

doi.org/10.1007/s40200-026-02114-zPubMed 42894545Interventions