Tirzepatide costs more than semaglutide almost everywhere here. Part of the reason is a general sense that it is the stronger drug. This trial tested a version of that belief against a different comparator, and the answer is narrower than the belief.
What the trial asked
It was an active-comparator, double-blind noninferiority trial in people with type 2 diabetes and atherosclerotic cardiovascular disease. [1] Participants were randomized 1:1 to weekly tirzepatide, titrated to as much as 15 mg, or to dulaglutide 1.5 mg — an older GLP-1 that the paper identifies as having already been shown to reduce cardiovascular events. 13,299 people were randomized, leaving 6,586 and 6,579 in the two analysis groups. Mean age was 64.1, mean HbA1c 8.4%, and mean diabetes duration 14.7 years.
The design matters more than usual here. A noninferiority trial asks whether the new drug is not meaningfully worse. The margin was set at 1.05 for the upper limit of the confidence interval. Superiority required that upper limit to fall below 1.00. Those are two different questions and the trial was built to answer the first. Which question a design can answer is settled before any data arrive — and so is which comparison gets reported, as the combination trial with an arm it never compared shows.
What it found
A primary endpoint event occurred in 801 patients on tirzepatide, 12.2%, and 862 on dulaglutide, 13.1%. The hazard ratio was 0.92 with a 95.3% confidence interval of 0.83 to 1.01. Noninferiority was met at P=0.003. Superiority was not, at P=0.09.
The upper bound is 1.01. It missed by a hundredth. That is worth saying plainly in both directions: the result is consistent with tirzepatide being modestly better, and the trial did not establish that it is.
Who paid, and who it was for
The trial was funded by Eli Lilly, which manufactures tirzepatide. That is ordinary for a cardiovascular outcomes trial and it is worth knowing, particularly for a result the sponsor would have preferred to be superior.
The population is also not the person reading this. These were people averaging nearly fifteen years of diabetes with established heart disease. Nothing here describes what either molecule does for cardiovascular risk in somebody buying for weight loss, and the cost of a cardiovascular result is a separate calculation entirely.
What it means for the price gap
Dulaglutide is not stocked by anybody on this roster, so this trial does not tell you which of two purchasable things to buy. What it does is put a limit on how much cardiovascular confidence the more expensive molecule has earned.
380 sellers here publish a price for both molecules by injection, read September 2026. Across those, tirzepatide runs a median of $60 more a month, with 341 charging more for it and 6 charging less. Whether that gap is worth paying is answered elsewhere on its own evidence, and this trial is one more input rather than the answer. You can see the current spread in the price check.