ICER Evaluates Cost-Effectiveness of Weight-Loss Drugs Amid Cardiovascular Benefits

On September 9, 2025, the Institute for Clinical and Economic Review (ICER) released a draft report evaluating the cost-effectiveness of GLP-1 receptor agonist weight-loss drugs, specifically Novo Nordisk's semaglutide (marketed as Ozempic and Wegovy) and Eli Lilly's tirzepatide (marketed as Mounjaro and Zepbound). The report indicates that these medications have become more cost-effective due to significant price reductions and demonstrated cardiovascular benefits.

Semaglutide's annual cost has decreased to approximately $6,830, while tirzepatide is priced around $7,973, with both drugs available to consumers at about $6,000 per year. ICER awarded the highest cost-effectiveness score to these drugs compared to lifestyle interventions like diet and exercise. However, the report notes that while tirzepatide shows greater weight loss and potentially fewer side effects, its cardiovascular benefits remain uncertain. Semaglutide has demonstrated reduced cardiovascular risks in certain patients. The report also highlights the financial challenges posed by rising drug costs, with U.S. spending on GLP-1 treatments reaching $72 billion in 2023. ICER emphasizes the need for a national approach to improve affordability and access for those most in need. A final report will be issued following a public meeting in November.

GLP-1 receptor agonists are a class of medications initially developed to treat type 2 diabetes by mimicking the incretin hormone GLP-1, which stimulates insulin secretion. Over time, these drugs have been found effective in promoting weight loss, leading to their approval for obesity management. Semaglutide and tirzepatide are among the most prominent GLP-1 receptor agonists currently available.

Recent studies have highlighted the cardiovascular benefits of GLP-1 receptor agonists. For instance, a real-world study presented at the European Society of Cardiology meeting demonstrated that Novo Nordisk's Wegovy (semaglutide) reduced the risk of heart attack, stroke, or death by 57% compared to Eli Lilly's tirzepatide. The study involved over 21,000 overweight and obese patients with cardiovascular disease but without diabetes. Major adverse cardiac events occurred in only 0.1% of Wegovy users versus 0.4% for tirzepatide users.

The high cost of GLP-1 receptor agonists has been a significant concern. In 2023, U.S. spending on these treatments reached $72 billion. Employers and insurers are grappling with the financial strain, with some considering reducing healthcare benefits due to the escalating costs. ICER's report underscores the necessity for a national approach to improve affordability and access for those most in need.

Additionally, the market is witnessing the development of oral versions of these drugs. Both Eli Lilly and Novo Nordisk are working on once-daily oral formulations targeting the GLP-1 hormone to expand market reach and cater to patients who avoid injections. Analysts predict that these oral drugs will be priced similarly to existing injectables, around $1,000 per month, due to their modest weight-loss efficacy compared to injections and competitive market dynamics.

The increasing availability and effectiveness of GLP-1 receptor agonists have significant societal implications. Obesity is a major public health issue, contributing to various chronic diseases, including cardiovascular conditions. Effective weight-loss medications can improve health outcomes and reduce the burden on healthcare systems. However, the high costs associated with these treatments raise concerns about equitable access, especially for underserved populations. ICER's emphasis on a national approach to affordability highlights the need for policies that ensure these life-changing medications are accessible to all who need them.

As the landscape of obesity treatment continues to evolve, stakeholders—including healthcare providers, policymakers, and pharmaceutical companies—must collaborate to balance the benefits of these innovative therapies with the imperative of making them affordable and accessible to the broader population.