The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

Abstract

Aim: To evaluate the cost–effectiveness of oral semaglutide+metformin versus empagliflozin+metformin in people with Type 2 diabetes uncontrolled on msetformin alone. Materials and methods: The IQVIA Core Diabetes Model was populated with efficacy data from a head-to-head study between oral semaglutide+metformin and empagliflozin+metformin. Danish costs and quality-of-life data were sourced from literature. Price per day was Danish Krone (DKK) 25.53 for oral semaglutide and DKK11.40 for empagliflozin. Discounting was fixed at 4%. Scenario and sensitivity analyses were performed. Results: Over a lifetime, Core Diabetes Model projected 8.78 and 8.75 quality-adjusted life-years and a total cost of DKK 447,633 and DKK 387,786, thereby generating an incremental cost–effectiveness ratio of DKK 1,930,548 for oral semaglutide+metformin versus empagliflozin+metformin. Scenario and sensitivity analyses showed the robustness of the outcomes. Duration of treatment with oral semaglutide is the key driver of the analyses. Conclusion: Oral semaglutide+metformin seems not cost effective versus empagliflozin+metformin in patients uncontrolled on metformin in Denmark.

The long-term cost-effectiveness of oral semaglutide versus empagliflozin and dulaglutide in Portugal

“…The approach used for HbA1c progression and treatment intensification in the present study was chosen to accurately reflect real-world clinical practice where treatments are continued while glycemic control is maintained, and intensified as type 2 diabetes naturally progresses over patients’ lifetimes [ 14 , 15 , 30 ]. Indeed, the lengths of time patients received oral semaglutide and dulaglutide in the present study (3 years) closely matched the published data from clinical practice in Europe, which indicated a substantially shorter treatment duration than the lifetime assumptions applied in the analyses published by the Institute for Clinical and Economic Review and Ehlers et al [ 48 , 50 , 51 ].…”

“…Previous studies have evaluated the cost-effectiveness of oral semaglutide versus empagliflozin and dulaglutide, including studies in the UK, the Netherlands and Sweden that have produced consistent results, and studies in the US and Denmark that have produced conflicting outcomes, particularly for the comparison of oral semaglutide versus empagliflozin [ 14 , 15 , 48 – 50 ]. Studies published in the UK by Bain et al, in the Netherlands by Malkin et al and in Sweden by Eliasson et al projected oral semaglutide to be cost-effective, while studies in the US and Denmark, published by the Institute for Clinical and Economic Review and Ehlers et al, respectively, predicted that oral semaglutide was not cost-effective [ 14 , 15 , 48 , 50 ]. However, the different methods used in these studies must be taken into account when comparing results.…”

“…However, the different methods used in these studies must be taken into account when comparing results. The UK and Netherlands studies utilized the same treatment intensification approach as the present study, whereby patients discontinued initial therapies after HbA1c exceeded 7.5%, but the US and Denmark studies applied a lifetime treatment duration for oral semaglutide and empagliflozin [ 14 , 15 , 48 , 50 ]. Maintaining GLP-1 receptor agonist and SGLT-2 inhibitor therapy for patients’ lifetimes is at odds with published data from general practice in Europe, which indicated an average duration of GLP-1 receptor agonist treatment of just over 29 months and a discontinuation rate of 45% for SGLT-2 inhibitors at 2 years [ 51 – 54 ].…”

Useful Oral Administration of Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA) as Semaglutide (Rybelsus) for Type 2 Diabetes Mellitus (T2DM)

“…The subjects were uncontrolled T2DM patients with metformin alone [17]. As a result, price/day was 25.53 vs 11.40 by Danish Krone (DKK), respectively.…”

Model‐based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease

“…Studies evaluating short term (3-5 years) budget impact of empagliflozin as add-on to SoC for the treatment of T2D with a history of CVD and/or increased risk of CVD from, for example, Greece, 18 Italy, 19 the UK 20 and South Africa, 21 have indicated both clinical benefits and cost savings. Other studies from the UK, 22,23 Greece 24 and the United States 25 have concluded that empagliflozin is costeffective in people with T2D and eCVD compared with SoC, or to comparator products such as semaglutide, 26 dapagliflozin, 27 sitagliptin 25 and liraglutide. 28 Support for implementation of empagliflozin was also found in a Swedish 5-year budget impact study based on register data of 5500 people with T2D and eCVD, which estimated a cost per quality-adjusted life year (QALY) of 8100 euros (EUR).…”