{"id":"ae8ec1a48b72","type":"article","url":"https://hartvaat.nl/2026/05/19/tirzepatide-bij-hfpef-obesitas-niet-kosteneffectief-en-niet-betaalbaar-tegen-hui/","title":"Tirzepatide bij HFpEF + obesitas: niet kosteneffectief en niet betaalbaar tegen huidige prijs in Duitsland","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["farmaco-economie","step-hfpef","summit-trial"],"journal":"International journal of cardiology","doi":"10.1016/j.ijcard.2026.134560","source_url":"https://doi.org/10.1016/j.ijcard.2026.134560","authors":["Bent Estler","Hanna Fröhlich","Tobias Täger","Jannick Heins","Norbert Frey","Lutz Frankenstein"],"significance":6,"published":"2026-06-15","source_date":"2026-05-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/"],"congress":"","summary_en":"Markov model of tirzepatide versus placebo (both on top of standard care) in the SUMMIT population (HFpEF + obesity) from the German payer perspective, with monthly cycles over 5 years and four KCCQ-defined health states plus death. Discounted per-patient costs: €5,827 (placebo) versus €31,052 (tirzepatide), with QALYs of 3.539 versus 3.638. Tirzepatide yielded 0.100 additional QALYs at incremental costs of €25,225, ICER €252,611/QALY — far above the €100,000/QALY threshold. Five-year budget impact: €1.9-6.2 billion under SUMMIT criteria and €3.8-12.6 billion under broad eligibility, depending on uptake (30/50/100%). Substantial price reduction would be needed for tirzepatide to be both cost-effective and affordable at population scale.","created":"2026-07-03T10:33:03Z","updated":"2026-07-03T13:31:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Markov-model van tirzepatide versus placebo (beide bovenop standaardzorg) bij de SUMMIT-populatie (HFpEF + obesitas) vanuit Duits zorgperspectief, met maandelijkse cycli over 5 jaar en vier KCCQ-gedefinieerde gezondheidsstadia plus overlijden. Gedisconteerde kosten per patiënt: €5.827 (placebo) versus €31.052 (tirzepatide), met QALY's van 3,539 versus 3,638. Tirzepatide leverde 0,100 extra QALY's bij incrementele kosten van €25.225, ICER €252.611/QALY — ver boven de €100.000/QALY-drempel. Vijfjarige budgetimpact: €1,9-6,2 miljard bij SUMMIT-criteria en €3,8-12,6 miljard bij brede toepassing, afhankelijk van uptake (30/50/100%). Aanzienlijke prijsreductie zou nodig zijn om economisch aantrekkelijk én betaalbaar te zijn op populatieniveau.","abstract_original":"BACKGROUND: Heart failure with preserved ejection fraction is common, obesity-related, and associated with high symptom burden and healthcare use. Tirzepatide, a dual GIP/GLP-1 receptor agonist, improved symptoms and outcomes in SUMMIT, but its acquisition cost raises concerns about value and affordability. METHODS: We developed a Markov model comparing tirzepatide versus placebo, both added to standard care, in the SUMMIT population from the German statutory health insurance perspective. The model used monthly cycles over 5 years with four Kansas City Cardiomyopathy Questionnaire clinical summary score-defined health states (Q1-Q4) plus death. Arm-specific transitions and rates of all-cause death and worsening heart failure were derived from SUMMIT. Deterministic and probabilistic sensitivity analyses, including tirzepatide price-reduction scenarios, were conducted to explore parameter uncertainty and price thresholds simultaneously. A prevalence-based budget impact analysis extrapolated results to the German HFpEF-obesity population under alternative eligibility (SUMMIT-like vs broad) and uptake (30%, 50%, 100%) scenarios. RESULTS: Discounted per-patient costs were €5827 (placebo) and €31,052 (tirzepatide), with quality-adjusted life years of 3.539 and 3.638. Tirzepatide generated 0.100 additional quality-adjusted life years at an incremental cost of €25,225, yielding an incremental cost-effectiveness ratio of 252,611€/quality-adjusted life year, with low probability of cost-effectiveness at €100,000/QALY. Five-year incremental spending was ∼€1.9-6.2 billion with SUMMIT-like and ∼ €3.8-12.6 billion with broad eligibility, depending on uptake. CONCLUSIONS: Tirzepatide provides modest quality-adjusted life year gains at substantially higher costs and, at current price, appears neither cost-effective nor affordable at scale in German care. Substantial price reductions would be required to improve economic attractiveness and budgetary impact."}