The UK's National Institute for Health and Care Excellence (NICE) has announced its decision to reimburse Eli Lilly's tirzepatide (Mounjaro) for obesity treatment, positioning the UK as the first country in Europe to provide reimbursement for this drug. This decision follows the publication of a head-to-head study comparing tirzepatide to Novo Nordisk’s semaglutide (Wegovy), with tirzepatide demonstrating superior weight loss results.
Clinical Evidence and NICE Guidelines
Eli Lilly's SURMOUNT-5 study, involving 700 patients, revealed that tirzepatide led to a 47% greater weight loss (25 kg vs. 16.5 kg) after 18 months when combined with a reduced-calorie diet and increased physical activity, compared to semaglutide. NICE has used this data to justify its decision to reimburse tirzepatide. However, NICE's guidelines specify that treatment will be prioritized for patients with a BMI of 35 or greater and at least one comorbidity, a stricter criterion than the marketing authorization which allows for treatment of patients with a BMI over 30.
Managed Rollout and Prioritization
Given the large eligible patient population in England (approximately 3.4 million), NICE emphasizes a carefully managed rollout to ensure healthcare professionals can meet the diverse health needs of all patients. Initially, individuals with the highest clinical need will be prioritized while the NHS tests new service models for obesity care. NHS England plans to publish interim commissioning guidance early next year, with tirzepatide being offered to high-need patients outside specialist weight management services starting 180 days after NICE's final guidance is published. Around 220,000 people are expected to benefit during the initial three-year rollout.
NHS Implementation and Cost Considerations
NICE's guidance specifies that the first NHS patients will be able to access the medicine 90 days after final guidance publication if they are already in specialist weight management services, or 180 days if they have the highest clinical priority. Tirzepatide, a self-administered weekly injection, is priced at £122 for four kwikpens at the maximum 15mg dose. The estimated cost to the NHS in England for the medicine and associated care services is approximately £317.2 million per year by the third year of implementation.
Impact on Obesity Treatment
According to the Health Survey for England 2022, approximately 64% of adults in England are overweight or living with obesity, making obesity the second most common cause of preventable death after smoking. NICE anticipates that tirzepatide will be a cost-effective use of NHS resources for certain patients, as weight loss in individuals with obesity and related illnesses reduces the risk of further health complications and saves money for the NHS.
