Are GLP-1s Worth What They Cost? 10 Economic Analyses (2026)

The independent benchmark, and the harshest number in this literature: a lifetime simulation putting semaglutide at roughly $197,000 per quality-adjusted life year and tirzepatide at roughly $468,000, against no drug treatment, in adults with obesity and no established heart disease. ★ The authors translate it into the only term that matters for policy — prices would have to fall about 30% and 80% respectively to reach the conventional threshold. Every counterargument on this page is in some sense a response to this paper.

PMID 40085108 ↗DOI 10.1001/jamahealthforum.2024.5586 ↗

The companion analysis, asking what Medicare coverage for obesity would cost rather than whether it is worth it. Ten-year incremental drug spending came out between roughly $35 billion and $166 billion depending on how many people took it up, with only modest offsets from prevented heart attacks and diabetes. ★ That range is the number the coverage debate has been conducted in. It informed the proposal CMS floated in November 2024, which was never finalized.

PMID 40279111 ↗DOI 10.1001/jamahealthforum.2025.0905 ↗

The first published model to clear the US threshold for Wegovy, at roughly $74,309 per quality-adjusted life year — comfortably under the threshold — in patients carrying obesity plus existing heart disease and no diabetes. The result depends entirely on carrying SELECT's 20% reduction in cardiac events across a lifetime horizon. ⚠ Novo Nordisk funded it. That does not make it wrong, and it does mean the assumptions driving a favorable result deserve reading rather than the headline.

PMID 39882599 ↗DOI 10.1080/13696998.2025.2459529 ↗

The original US analysis, from before the cardiovascular data existed: semaglutide at about $111,251 per quality-adjusted life year against diet and exercise over 30 years — just above the line, which is the most consequential place a number can land. ★ This is where prior authorization criteria came from. It is the paper insurers cited when declining to cover Wegovy for weight alone, and it was overtaken as soon as the cardiovascular indication arrived.

PMID 35737858 ↗DOI 10.18553/jmcp.2022.28.7.740 ↗

The tirzepatide counterpart at roughly $134,275 per quality-adjusted life year against lifestyle change — above the threshold but nowhere near the independent estimate of $468,000. ★ Read the two together, because the gap between them is instructive: it comes down to assumptions about how much weight comes back after stopping, how much downstream disease gets prevented, and whether the model uses list or net price. Eli Lilly funded this one. It is the sponsor-side bookend.

PMID 40512029 ↗DOI 10.1002/oby.24310 ↗

The adolescent analysis, and the one place where the arithmetic behaves unexpectedly. Modeling teenagers aged 12 to 17 with severe obesity over a lifetime, semaglutide came out near $237,000 per quality-adjusted life year and liraglutide near $190,000, while the much older phentermine-topiramate combination was cost-saving. ⚠ Treating young patients means many more years of remaining life to benefit — but also many more years of paying for the drug, and the second effect wins at current prices. It is the reference behind Medicaid decisions on adolescent coverage.

PMID 37824146 ↗DOI 10.1001/jamanetworkopen.2023.36400 ↗

The paper that undermines the inputs of nearly every other analysis here. Using rebate data, it estimates that the actual post-rebate price paid for Wegovy and Zepbound is roughly half the list price the models used. ★ If that is right, most published cost-effectiveness ratios overstate the real burden on payers by a wide margin — which is precisely the argument manufacturers make, resting on independent work. It is the strongest reason to distrust any analysis anchored on sticker price.

PMID 38228492 ↗DOI 10.1002/oby.23973 ↗

The most practically interesting model on this page: what if the drug were used as induction rather than forever — full dose to reach target weight, then step down to a cheaper maintenance approach. That produced ratios in the $50,000 to $100,000 range, inside the threshold, and cut ten-year payer spending by 30 to 60%. ⛔ The catch is unavoidable and this site documents it elsewhere: the withdrawal trials show weight comes back. The model's value depends entirely on whether a cheaper maintenance strategy can hold it, which no trial has demonstrated.

PMID 38828004 ↗DOI 10.1093/haschl/qxae055 ↗

The comparison that shows how much of this is about the US specifically. Under Canadian negotiated pricing, both semaglutide and tirzepatide fall below Canada's conventional threshold — cost-effective, on the same clinical evidence that fails the test in American models. ★ Bariatric surgery came out dominant: both cheaper and more effective over a lifetime. Same drugs, same trials, opposite verdict, and the only variable that moved was price.

PMID 40686094 ↗DOI 10.1111/dom.16627 ↗

The synthesis across more than 20 published economic evaluations, and the entry to read if you only read one. Its findings: these drugs are rarely cost-effective at US thresholds and frequently cost-effective in European and UK systems at negotiated prices — and manufacturer-funded studies reported ratios about 40% more favorable than independent ones. ★ That funding gap is the most useful single fact in this literature. Check who paid before you weigh any number on this page.

PMID 41365841 ↗DOI 10.1111/dom.70322 ↗