Cost-Utility Analysis of Once-Weekly Semaglutide, Dulaglutide, and Exenatide for Type 2 Diabetes Patients Receiving Metformin-Based Background Therapy in China

Abstract

Introduction: The substantial financial burden associated with type 2 diabetes (T2D) over a lifetime cannot be neglected. Therefore, the objective of this study was to evaluate the pharmacoeconomic value of three once-weekly GLP-1 RAs, namely subcutaneous semaglutide (sc. SEMA), dulaglutide (DULA), and extended-release exenatide (e-r EXEN), in treating patients with T2D that cannot be controlled with metformin-based background therapy, and to find a suitable price reduction for non-cost-effective medications, to provide reasonable recommendations to the administration for adjusting drug prices.Methods: The baseline characteristics of the simulation patient cohort were sourced from a comprehensive meta-analysis synthesizing 453 trials evaluating 21 hypoglycemic agents from nine categories of drugs. The UKPDS OM2 was applied to project the long-term effectiveness and costs from a Chinese health care provider’s perspective. After cost-utility analysis, the reasonable price adjustment of non-cost-effective options was explored via binary search. Uncertainty was measured by means of sensitivity analysis.Results: After a 40-year simulation, the sc. SEMA, DULA, and e-r EXEN groups yielded 9.6315, 9.5968, and 9.5895 quality-adjusted life years (QALYs), respectively. In terms of expenditure, the total costs for the sc. SEMA, DULA, and e-r EXEN groups were $42012.47, $24931.27, and $40264.80, respectively. DULA was dominant over e-r EXEN due to the higher QALYs and lower total costs. The ICURs of sc. SEMA vs. DULA and sc. SEMA vs. e-r EXEN were $492994.72/QALY and $41622.69/QALY (ICUR > λ), respectively, indicating that sc. SEMA was not more cost-effective than DULA or e-r EXEN. The INMB and absolute NMB yielded the same conclusions which were robust to one-way, scenario, and probabilistic sensitivity analyses. After several assumptions in the binary search, sc. SEMA and e-r EXEN appear to become cost-effective when their annual costs are decreased by 57.67% and 70.34%, respectively, with DULA as a counterpart.Conclusion: From the cost-utility analysis, DULA appears to be the most cost-effective option among sc. SEMA, DULA, and e-r EXEN for the treatment of patients with T2D receiving metformin-based background therapy. With a 57.67% or 70.34% reduction in cost, sc. SEMA or e-r EXEN, respectively, would become as cost-effective as DULA in China.

Cost‐utility analysis of semaglutide for type 2 diabetes after its addition to the National Medical Insurance System in China

“…SEMA was not approved for the Chinese market by the National Medical Products Administration until 2021. According to our previous research, 17 SEMA did not appear to be cost‐effective versus DULA when SEMA first entered the Chinese market at a relatively high price.…”

Effectiveness and cost-effectiveness of six GLP-1RAs for treatment of Chinese type 2 diabetes mellitus patients that inadequately controlled on metformin: a micro-simulation model

“…Compared with previous similar studies ( 2 , 53 , 54 ), our study has the following advantages. First, we are the first to systematically compare the efficacy and cost-effectiveness of GLP-1RAs approved in China, thereby providing comprehensive evidential support for clinical rational drug use and medical service decision-making.…”

“…Currently, there are few research articles on the cost-effectiveness of GLP-1RAs. Hu et al ( 53 ) evaluated the cost-effectiveness of semaglutide, dulaglutide, and extended-release exenatide in treating patients with T2DM which cannot be controlled with metformin-based background therapy. They found that dulaglutide appeared to be the most cost-effective option, which was consistent with our findings.…”

Assessment of Changes in Body Composition After 3 Months of Dulaglutide Treatment

“… 9 It has been widely used to treat T2DM in China, especially in patients who are overweight or obese. 10 Although the subgroup analysis of the AWARD studies showed that dulaglutide significantly improved glycemic control, reduced the risk of weight gain and had acceptable gastrointestinal side effects in the Chinese population, 11 , 12 research data on dulaglutide in the Chinese population are limited. The obesity profile and fat distribution of the Chinese population are different from those of the European and American populations considering ethnic and dietary characteristics.…”