The initiative has been outlined in final draft healthcare guidance from NICE but will still need to be accompanied by increased physical activity and a reduced calorie diet.

The National Institute for Health & Care Excellence is recommending tirzepatide for people with a BMI over 35 and at least one weight-related illness.

It’s estimated that that criteria could cover around 3.4 million residents in England, meaning the initial 250,000 rollout will need to be targeted at those that will most benefit. Plans are for those with the highest clinical need to be prioritised first.

Following on from a consultation in October of this year on NHS England’s request for the rollout to be extended over 12 years, NICE published these new guidelines.

Priority will begin with those already in specialist weight management services, who should be able to access tirzepatide within 90 days of NICE’s final guidance.

Plans for other patient cohorts will continue to be developed over the next three years.

Weight-related illnesses noted in this guidance include:

• Hypertension
• Dyslipidaemia
• obstructive sleep apnoea
• cardiovascular disease
• prediabetes
• type 2 diabetes.

NHS England hope to publish interim commissioning guidance early on in 2025, with patients outside specialist services starting to receive tirzepatide 180 days after NICE’s final guidance. An estimated 220,000 people are expected to benefit during that initial three-year period.

During this time, evidence will be gathered to understand the most effective care forms, informing a NICE re-evaluation for the wider rollout.

“The world will look very different in three years which is why we’ve taken the unprecedented decision to review the way this medicine is delivered to patients then. Tirzepatide and other drugs like it, such as semaglutide, will help people living with obesity to lose weight, and as a result will reduce their risk of developing heart disease or having a stroke. But tirzepatide is not for everybody, and only those with the highest clinical need will be treated initially. This means many people will have to wait. We have had to make this difficult decision in order to protect other vital NHS services and also to test ways of delivering this new generation of weight loss medications. We want to help NHS England carefully manage the roll out of tirzepatide to ensure that other services are not impacted in a disproportionate way. Whilst the funding variation sets a maximum of 12 years, NICE will review the situation again within 3 years and provide further advice on how the roll out of this medicine can be managed using the learning gained from the initial phase. This will ensure the roll out of tirzepatide reaches everyone who is eligible in a safe and effective way.”

Professor Jonathan Benger – Chief Medical Officer, NICE

During clinical trials, patients were seen to lose an average of 21% of their total body weight in thirty-six weeks, at a cost of £122 for four kwikpens at a maximum dose of 15mg.

Total cost to the NHS over the first three years is estimated at around £317.2m per year but NICE’s research shows that that tirzepatide will still be cost effective when available on the NHS overall. Weight loss in patients with obesity and weight-related illnesses reduces the risk of further health complications, preventing future ill health and saving NHS resources.

“Obesity is one of the greatest public health issues facing the NHS and weight loss drugs, such as tirzepatide, are an important tool in helping people lose weight while also reducing the risk of other serious long-term conditions such as diabetes, strokes and heart attacks. However, on their own, weight loss drugs are not a magic bullet. They need to be prescribed by a healthcare professional alongside programmes that help people lose weight and live healthier lives by making changes to their diet and physical activity – and it’s also crucial that they are prioritised for those who need them most. This guidance enables the NHS to implement a phased roll out of tirzepatide to patients with the highest clinical need in a safe and effective way, while also protecting access to the NHS services that all patients rely on.”

Dr. Kath McCullough – Specialty Advisor for Obesity, NHS England