Emil Panzaru and I recently published in Economic Affairs Volume 45, Issue 3 “Societal value and health economic benefits of GLP-1 drugs in the United States” and today Institute for Clinical and Economic Review (ICER) came to similar conclusions: ICER’s October 29, 2025 evidence report on semaglutide and tirzepatide for obesity lands squarely in support of our central claim: these therapies deliver enough health benefit to be cost-effective even at prices above today’s estimated net levels.
ICER’s Health Benefit Price Benchmarks (HBPB) put both injectable semaglutide (Wegovy) and tirzepatide (Zepbound) in ranges higher than current net prices, concluding that “no discount is needed” to reach standard U.S. value thresholds. In other words, the independent HTA most U.S. payers watch just validated the core of our argument. Start with the numbers. ICER defines HBPB as the price range that achieves incremental cost-effectiveness between $100,000 and $150,000 per QALY/evLY (equal-value life-year).
Against that yardstick, ICER estimates: injectable semaglutide value justifies ~$9,100–$12,500 per year; tirzepatide ~$11,500–$15,800 per year. ICER pairs those ranges with current net prices of $6,829 (injectable semaglutide) and $7,973 (tirzepatide) and states explicitly that no discounts are needed at those net prices to meet value thresholds. ICER assumes oral semaglutide’s net equals the injectable for modeling and likewise finds no discount necessary. These figures mirror the pricing logic in our paper and, critically, show headroom without breaching conventional value bars. Clinical effectiveness judgments also reinforce our position that these drugs offer substantial net health benefit relative to lifestyle modification alone.
ICER assigns an “A” evidence rating (high certainty of substantial net benefit) to injectable semaglutide, oral semaglutide, and tirzepatide versus lifestyle, reflecting consistent weight-loss benefits and downstream risk reductions. Where ICER appropriately tempers conclusions is in head-to-head comparisons: tirzepatide vs. semaglutide is rated P/I (“promising but inconclusive”), largely because comparative cardiovascular outcome data remain unsettled; oral semaglutide vs. injectable gets a C- (comparable or worse). Our paper noted the same evidentiary gap on cardiovascular outcomes and did not hinge its value case on superiority claims – a stance ICER’s ratings vindicate. Importantly, ICER’s methods section clarifies the linkage between HBPB and the familiar $100k–$150k/QALY range — the same threshold space we used to frame acceptable value. By aligning on thresholds and modeling perspective (health-care sector), ICER’s analysis serves as an external replication of our conclusion: at today’s net prices the cost-effectiveness math already works, and higher prices are still compatible with value so long as they remain within the HBPB ranges.
That congruence in both framework and finding strengthens the credibility of our original estimates. Where both papers also converge – and where headline readers often miss the nuance – is the affordability constraint. ICER’s budget impact analysis, which applies its standard uptake and eligibility assumptions, finds that fewer than 1% of eligible patients could be treated before crossing ICER’s annualized potential budget-impact threshold. This is paired with a threshold level ICER calculates at roughly $880 million per year for new drugs over 2024–2025.
The implication matches our argument: value and affordability are distinct. A treatment can be good value at the margin yet still pose system-level budget pressure if demand is massive – prompting payers to ration through coverage criteria, step edits, or caps. ICER’s analysis surfaces exactly that tension. Policy-wise, ICER’s conclusions nudge stakeholders toward access strategies rather than blunt price cuts: coverage that prioritizes high-risk patients; outcomes-based contracts that tie net cost to realized cardiometabolic benefits; and benefit-design tweaks to limit patient abandonment.
Our paper argued that such levers can expand responsible access without undermining value – a viewpoint that is easier to defend now that ICER has independently shown no discount is required to hit cost-effectiveness targets at prevailing net prices. Finally, ICER explicitly flags the evidence frontier we highlighted: long-term durability, real-world adherence, and especially cardiovascular outcomes differentials between agents. Those uncertainties don’t overturn the value case; rather, they define the conditions for price resilience as new data arrive. By separating “is it worth it at the margin today?” (yes, within HBPB) from “how many can we afford tomorrow?” (not many under current budgets), ICER’s report provides a disciplined echo of our thesis and a practical roadmap for payers and policymakers.
Bottom line: ICER’s revised report corroborates our key findings on cost-effectiveness headroom for Wegovy and Zepbound, affirms substantial net benefit vs. lifestyle, and underscores the affordability pinch that calls for smart access management — not reflexive price cuts. That is precisely the balance our paper advocated.
