Cost-effectiveness and budget-impact analysis of tirzepatide in heart failure with preserved ejection fraction and obesity in the German health-care system

At current pricing in Germany, tirzepatide is unlikely to be cost-effective or affordable at scale for heart failure with preserved ejection fraction and obesity, despite adding modest quality-adjusted life-year gains. A Markov model based on the SUMMIT population estimated an incremental cost-effectiveness ratio of about €252,611 per QALY and five-year incremental spending in the billions under different eligibility and uptake scenarios.

Journal article — Cost-effectiveness and budget-impact analysis. Population: SUMMIT population with heart failure with preserved ejection fraction and obesity, modelled from the German statutory health insurance perspective. Follow-up: 5 years. Interventions: tirzepatide added to standard care.

Discounted per-patient costs were €5,827 for placebo and €31,052 for tirzepatide. QALYs were 3.539 for placebo and 3.638 for tirzepatide, giving 0.100 additional QALYs at an incremental cost of €25,225 and an ICER of €252,611/QALY. The probability of cost-effectiveness at €100,000/QALY was low. Depending on eligibility (SUMMIT-like vs broad) and uptake (30%, 50%, 100%), five-year incremental spending was estimated at about €1.9-6.2 billion and €3.8-12.6 billion, respectively.

For researchers studying tirzepatide, this paper provides a German-system economic translation of the SUMMIT efficacy data, quantifying a high ICER and large projected spending increases at the current price. It does not establish clinical efficacy, safety, dosing, or a specific price threshold, and it gives no treatment recommendation.

Key findings

• Tirzepatide added 0.100 QALYs (3.638 vs 3.539) at an incremental cost of €25,225 versus placebo.
• The incremental cost-effectiveness ratio was €252,611 per QALY, with a low probability of being cost-effective at €100,000/QALY.
• Discounted per-patient costs were €31,052 for tirzepatide versus €5,827 for placebo.
• Estimated five-year incremental spending was about €1.9-6.2 billion under SUMMIT-like eligibility and €3.8-12.6 billion under broad eligibility, depending on uptake.

Limitations

• Model-based analysis relies on assumptions and extrapolation from SUMMIT rather than direct German patient-level data.
• Findings are limited to the German statutory health insurance perspective and may not transfer to other countries or payers.
• The 5-year horizon and hypothetical eligibility/uptake scenarios leave long-term value and real-world budget impact uncertain.

The record

• Journal: International journal of cardiology 458: 134560
• Published: 2026-05-19
• PMID: 42155673 — DOI: 10.1016/j.ijcard.2026.134560
• MeSH terms: Humans, Obesity, Stroke Volume, Cost-Benefit Analysis, Budgets, Germany, Male, Heart Failure, Cost-Effectiveness Analysis, Tirzepatide
• Author countries: Germany

Peptide profiles: Tirzepatide.

All indexed evidence: Tirzepatide trials & papers.

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