Zepbound Lowers Health Care Costs in Older Adults With Obesity

Adults older than 55 years with overweight or obesity, but without type 2 diabetes, who started tirzepatide (Zepbound) had significantly lower health care costs than matched untreated peers within a year of treatment, according to a real-world matched-cohort study published in Diabetes, Obesity and Metabolism.¹

The analysis, funded by Eli Lilly and Company, compared 15,843 tirzepatide initiators with 15,843 propensity-matched adults who received no incretin-based weight management therapy, using claims data from the Komodo Research Dataset spanning November 8, 2022, through September 30, 2025.¹

Eli Lilly, tirzepatide's manufacturer, highlighted the findings, saying the results could inform coverage decisions for weight management medications.²

"This compelling real-world evidence highlights the impact that treating obesity with Zepbound can have on older patients and the healthcare system," Ilya Yuffa, executive vice president and president of Lilly USA and Global Customer Capabilities, said in a news release.²

Costs Diverged Over 18 Months

Researchers tracked all-cause health care costs, excluding tirzepatide itself, at 3 to 6 months, 6 to 12 months, and 12 to 18 months after treatment initiation, comparing each period against a 12-month baseline. In the study's primary analysis, which adjusted for patients dropping out of follow-up using a technique called inverse-probability-of-censoring weighting, monthly costs in the tirzepatide group stayed close to baseline, moving from $1,061 to $955 over 18 months, while costs in the untreated control group rose from $1,031 to $1,244 over the same period.¹

That divergence produced a statistically significant difference of $145 per person per month at 6 to 12 months (95% CI, -266 to -25; P = .022), a 12.3% relative reduction, and $319 per person per month at 12 to 18 months (95% CI, -544 to -94; P = .015), a 25.4% relative reduction, favoring the tirzepatide group.¹

A supporting sensitivity analysis using a different method to handle differential follow-up time, called pairwise censoring, showed an even larger gap: $181 per person per month at 6 to 12 months (95% CI, -319 to -43; P = .021) and $607 per person per month at 12 to 18 months (95% CI, -1007 to -207; P = .023). The study authors treated the inverse-probability-weighted results as primary because fewer than 10% of patients remained uncensored by the 12- to 18-month mark, raising concerns that the pairwise approach could be more sensitive to differences in which patients remained in each group that long.¹

The cost gap tracked closely with hospital use. Patients in the tirzepatide group had a more favorable change in inpatient admissions and emergency department visits relative to baseline than the control group at every follow-up window, with incidence rate ratios of 0.86 at 3 to 6 months (95% CI, 0.74-0.99; P = .033), 0.76 at 6 to 12 months (95% CI, 0.64-0.89; P = .001), and 0.69 at 12 to 18 months (95% CI, 0.50-0.94; P = .021).¹

Rates of outpatient and office visits did not differ significantly between groups, though tirzepatide patients numerically had more of them, a pattern the study authors said may reflect greater engagement with routine care after starting treatment.¹

Implications for the Medicare Bridge Program

The findings arrive as the Centers for Medicare & Medicaid Services runs its GLP-1 Bridge program, an 18-month demonstration that subsidizes access to incretin-based weight management drugs, including tirzepatide, orforglipron, and semaglutide, for eligible beneficiaries.^1,3

Under the negotiated pricing, beneficiaries pay $245 for a 30-day supply with a $50 copay, leaving Medicare a net cost of $195 per month.¹ Bryan Wheeler, PharmD, a staff pharmacist at Dickson Medical Pharmacy, White Bluff Pharmacy, and Hilltop Pharmacy, described the program's purpose.³

"The Medicare GLP-1 Bridge is a test program meant to help eligible Medicare patients get GLP-1 weight loss drugs. Starting July 1, 2026, the Centers for Medicare & Medicaid Services will use this program to decide if these drugs should be a permanent part of Medicare,” he said.³

The study authors wrote that the $319 monthly cost offset observed at 12 to 18 months "has implications" for that $195 net cost, suggesting tirzepatide could generate near-term savings for Medicare among beneficiaries who remain on treatment. In a July 2026 Institute for Clinical and Economic Review (ICER) analysis, the authors found that medical cost offsets from glucagon-like peptide-1 (GLP-1) therapies had appeared primarily in patients with both obesity and diabetes on injectable agents, while obesity-only populations often saw increased spending.³

The new study's population excluded anyone with diabetes, and its authors described it as the first to assess real-world cost offsets specifically in older adults treated with tirzepatide.¹

The same ICER analysis put tirzepatide's cost at $57,779 per quality-adjusted life-year versus lifestyle modification alone, the lowest of the GLP-1 options it reviewed, but warned that treating just 1% of eligible patients would exceed the organization's roughly $880 million annual budget impact threshold.³

Not every pharmacy stakeholder is convinced the economics favor wide GLP-1 coverage. "I just don't think that GLP-1s, or any expensive brand medication necessarily, are really great investments for local independent pharmacies," Jay Bregman, founder and CEO of Andel, told Drug Topics®.³

Limitations

The study authors cautioned that their findings apply only to patients who remained on tirzepatide, since anyone who discontinued treatment was censored from the analysis at that point. Results cannot be extrapolated to patients after they stop the drug. The analysis also could not capture tirzepatide obtained through cash pay, compounding, or directly from the manufacturer, which may have misclassified some individuals in the untreated control group and could understate the true cost difference.¹

The authors noted residual confounding from unmeasured factors, such as socioeconomic status and health literacy, cannot be excluded and that claims-based data are subject to coding and misclassification errors. The ICER report separately noted that real-world persistence with GLP-1 therapies tends to fall below clinical trial levels and that weight regain can occur within 1.5 years of discontinuation even with continued lifestyle management, underscoring why persistence may be central to whether the cost benefits described in the new study hold up in practice.³

REFERENCES

1. Upadhyay N, Bonakdar A, Subedi K, Banerjee S, Behrend B, Hankosky ER. Trends in Cost of Care With Tirzepatide in Adults Aged Over 55 Years With Obesity or Overweight Without Diabetes: A Matched Cohort Analysis. Diabetes Obes Metab. Published online August 24, 2026. doi:10.1111/dom.71250

2. Eli Lilly and Company. Zepbound linked to lower healthcare costs in adults over age 55 with obesity according to a real-world study. News release. Eli Lilly and Company. August 26, 2026. Accessed August 27, 2026. https://investor.lilly.com/news-releases/news-release-details/zepbound-linked-lower-healthcare-costs-adults-over-age-55

3. Gallagher A. ICER report finds GLP-1s are cost-effective but warns of budget strain. Drug Topics. July 21, 2026. Accessed August 27, 2026. https://www.drugtopics.com/view/icer-report-finds-glp-1s-are-cost-effective-but-warns-of-budget-strain