NHS England has proposed a phased rollout of tirzepatide, known as Mounjaro®, for treating obesity, aiming to optimize clinical benefits while managing resource allocation. The initiative prioritizes patients most likely to benefit from weight loss, integrating the medication into new service models that will be tested before broader implementation.
The plan involves developing community-based services and digital technologies to administer the injection to approximately 250,000 individuals over the initial three years. This approach is part of an application submitted to the National Institute for Health and Care Excellence (NICE).
Phased Implementation and Eligibility
The proposed rollout's extended duration reflects the need for careful evaluation and adaptation. New methods for delivering obesity medications, including digital platforms, will be explored to facilitate more rapid expansion. A consultation on the plan is currently open to registered stakeholders for three weeks, after which NICE will consider the feedback before issuing final guidance on tirzepatide and obesity later this year.
Eligibility criteria for the initial rollout include individuals with a body mass index (BMI) exceeding 40 and at least three specified weight-related health issues such as hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease. Subsequent phases would extend eligibility to those with a BMI over 40 and fewer weight-related health problems.
Clinical Evidence and Cost-Effectiveness
Tirzepatide has demonstrated superior efficacy compared to diet and exercise alone, and when compared to semaglutide alongside diet and exercise support. The SURMOUNT-4 trial showed that patients lost an average of 20.9% of their body weight over 36 weeks. NICE's independent committee has recommended the weekly injection, priced at £122 per month at the maximum 15mg dose, deeming it both effective and cost-effective.
Integrated Care Approach
The treatment will be integrated into a comprehensive package that includes diet and exercise support, delivered through primary or secondary care settings. A multidisciplinary team (MDT) comprising a dietitian, psychologist, and physical activity instructor will provide holistic care.
Expert Commentary
Dr. Sam Roberts, chief executive of NICE, stated, "This new generation of weight loss medications has the potential to achieve important health and wellbeing benefits for people living with obesity. They can also prevent serious health problems from developing, reducing the long-term risks to individuals... Because of the very large number of people who could potentially benefit, NICE accepts that a phased roll out is required. However, we now need to hear from stakeholders on the proposals we have received from NHS England."
