Evidence reference only. Not medical advice, not a dosing guide, and not a recommendation to use any drug.
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Cost and sticking with it

6 findings across 4 drug records. Domain pages are descriptive indexes, not advice.

The grade rates how strong the evidence is, not how good or safe the drug is. A low or very-low grade means the evidence is thin, not that an effect is harmful or ruled out.

Most represented records

GLP-1-based therapies, multi-agent (2)

Tirzepatide (2)

Semaglutide (1)

Tirzepatide and semaglutide comparison (1)

Evidence spread

High evidence 0 Moderate evidence 0 Low evidence 6 Very low evidence 0

GLP-1-based therapies, multi-agent STATUS UNKNOWN
Cost and sticking with it Not directional
Low evidence

In a real-world US commercially insured cohort of obese adults WITHOUT diabetes newly initiating GLP-1 therapy for weight loss, only 32.3% remained persistent at 1...

Gleason PP, Urick BY, Marshall LZ, Friedlander N, Qiu Y, Leslie RS. Real-world persistenc... Source
Full findingIn a real-world US commercially insured cohort of obese adults WITHOUT diabetes newly initiating GLP-1 therapy for weight loss, only 32.3% remained persistent at 1 year and only 27.2% were adherent (PDC>=80%) - far below the >85% adherence reported in pivotal obesity trials. (Note: this is the diabetes-free obesity stratum, which persists worse than type 2 diabetes; cf. ADHERENCE-02.)
PopulationRetrospective cohort, Prime Therapeutics integrated pharmacy + medical claims (~16.5M monthly commercially insured members); 4,066 obese adults WITHOUT type 2 diabetes initiating GLP-1 in 2021; mean age 46, 81% female; obesity (weight-loss) indication; USA.
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
Tirzepatide and semaglutide comparison STATUS UNKNOWN
Cost and sticking with it Not directional
Low evidence

In the largest US real-world EHR cohort, MOST patients with overweight/obesity discontinued GLP-1 RA within 1 year, with discontinuation substantially higher in...

Rodriguez PJ, Zhang V, Gratzl S, Do D, Goodwin Cartwright B, Baker C, Gluckman TJ, Stucky... Source
Full findingIn the largest US real-world EHR cohort, MOST patients with overweight/obesity discontinued GLP-1 RA within 1 year, with discontinuation substantially higher in obesity-without-diabetes (64.8%) than in type 2 diabetes (46.5%); discontinuation was associated with cost/coverage proxies (income) and GI adverse events, while greater weight loss protected against stopping.
PopulationRetrospective cohort, Truveta EHR (collective of US health systems); 125,474 adults (BMI>=27) newly initiating liraglutide, semaglutide or tirzepatide 2018-2023; mean age 54.4, 65.4% women; 61.0% with T2D; obesity vs T2D strata; followed up to 2 yr; USA.
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
GLP-1-based therapies, multi-agent STATUS UNKNOWN
Cost and sticking with it Not directional
Low evidence

In a nationwide T2D real-world database, adherence and persistence to GLP-1 RA were significantly higher for once-weekly than daily formulations and were...

Kassem S, Khalaila B, Stein N, Saliba W, Zaina A. Efficacy, adherence and persistence of ... Source
Full findingIn a nationwide T2D real-world database, adherence and persistence to GLP-1 RA were significantly higher for once-weekly than daily formulations and were socio-economically patterned (better adherence with higher socio-economic status), showing real-world persistence varies markedly by agent/dosing schedule and by access, even within type 2 diabetes.
PopulationRetrospective cohort, Clalit Health Services EMR (Israel, nationwide HMO); 70,654 adults with T2D purchasing any GLP-1 RA 2009-2021; 51% female; T2D indication.
Fundingacademic/independent analysis (manufacturer not study sponsor; per-study COI not individually audited)
Comparatorsonce-weekly vs daily GLP-1 RA
Semaglutide MARKETED
Cost and sticking with it Not directional
Low evidence

In a MANUFACTURER-SPONSORED (Novo Nordisk) Markov cost-effectiveness model of semaglutide 2.4 mg in the SELECT population (overweight/obese with established CV...

McEwan P, Bog M, Faurby M, Foos V, Lingvay I, Lubker C, Miller R, Toliver JC, Yeates F, L... Source
Full findingIn a MANUFACTURER-SPONSORED (Novo Nordisk) Markov cost-effectiveness model of semaglutide 2.4 mg in the SELECT population (overweight/obese with established CV disease, no diabetes), semaglutide was reported cost-effective at US list price against a $150,000/QALY willingness-to-pay threshold. Context-only economic observation; the headline result is highly price-assumption-dependent and sponsor-authored, so it is paired here with the independent competing null.
PopulationCohort-level Markov state-transition cost-effectiveness model; simulated 100,000 subjects aligned to SELECT (NCT03574597) baseline; healthcare-sector perspective; USA; sponsor Novo Nordisk (four of ten authors Novo employees, others Novo-commissioned HEOR Ltd).
Fundingindustry - Novo Nordisk (sponsor-authored cost-effectiveness model)
Comparatorsplacebo; standard of care
Tirzepatide MARKETED
Cost and sticking with it Not directional
Low evidence

In an INDEPENDENT (non-manufacturer) US lifetime microsimulation, tirzepatide and semaglutide added to lifestyle modification produced the largest QALY gains among...

Hwang JH, Laiteerapong N, Huang ES, Kim DD. Lifetime Health Effects and Cost-Effectivenes... Source
Full findingIn an INDEPENDENT (non-manufacturer) US lifetime microsimulation, tirzepatide and semaglutide added to lifestyle modification produced the largest QALY gains among anti-obesity medications yet were NOT cost-effective at current US net prices: at a $100,000/QALY threshold both had a 0% probability of being cost-effective across the examined range. Context-only economic observation; not an efficacy or value verdict.
PopulationLifetime cost-effectiveness analysis - individual-level microsimulation (validated Diabetes-Obesity-Cardiovascular Disease microsimulation model) parameterised from NHANES 2017-2020 survey data (4,823 individuals representing ~126M US adults meeting trial inclusion criteria); academic authors (University of Chicago); USA.
Fundingacademic/independent (University of Chicago authors; non-manufacturer; per-paper COI statement not individually audited)
Comparatorssemaglutide; naltrexone-bupropion; phentermine-topiramate; lifestyle modification
Tirzepatide MARKETED
Cost and sticking with it Not directional
Low evidence

In two large US claims/EHR databases, most adults WITHOUT type 2 diabetes who initiated tirzepatide were still persistent at 6 months - a higher 6-month persistence...

Gibble TH, Hankosky ER, Meeks A, Liao B, Ward J, Huang A, Chinthammit C. Characteristics ... Source
Full findingIn two large US claims/EHR databases, most adults WITHOUT type 2 diabetes who initiated tirzepatide were still persistent at 6 months - a higher 6-month persistence than has typically been reported for older GLP-1 receptor agonists. Context-only real-world utilisation observation; short follow-up, not comparable to the 1-year discontinuation anchor.
PopulationRetrospective observational claims/EHR cohort, Merative MarketScan Commercial + Optum Clinformatics (CDM); adults without T2D initiating tirzepatide May 2021-Sep 2023; USA; sponsor Eli Lilly.
Fundingindustry - Eli Lilly (sponsor-authored real-world claims study)