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

Malkin, Samuel J. P.; Carvalho, Davide; Costa, Catarina; Conde, V; Hunt, Barnaby

doi:10.1186/s13098-022-00801-4

Cited by 6 publications

(7 citation statements)

References 53 publications

(99 reference statements)

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“…Studies in multiple countries have also variously found oral or s.c. formulations of semaglutide to be cost-effective compared with medications such as insulin, empagliflozin, liraglutide, and dulaglutide for the treatment of T2D [28][29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Impact of BMI and comorbidities on efficacy of once‐weekly semaglutide: Post hoc analyses of the STEP 1 randomized trial

McGowan

Houshmand-Oeregaard

Laursen

et al. 2023

Obesity

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Objective: This study assessed the effects of semaglutide on body weight, cardiometabolic risk factors, and glycemic status in individuals categorized by baseline BMI with or without additional obesity-related comorbidities, including prediabetes and high risk of cardiovascular disease (CVD).Methods: This was a post hoc exploratory subgroup analysis of the Semaglutide Treatment Effect in People with Obesity (STEP) 1 trial (NCT03548935), in which participants without diabetes and BMI ≥30 kg/m 2 , or BMI ≥27 kg/m 2 with ≥1 weightrelated comorbidity, were randomized to once-weekly subcutaneous semaglutide 2.4 mg or placebo for 68 weeks. For this analysis, individuals were categorized into subgroups based on baseline BMI <35 versus ≥35 kg/m 2 (with no additional criteria, with ≥1 comorbidity, with prediabetes, and with prediabetes and high risk of CVD).Results: Mean changes in body weight from baseline to week 68 with semaglutide were À16.2% and À14.0% in the subgroups with baseline BMI <35 and ≥35 kg/m 2 , respectively (both p < 0.0001 vs. placebo). Similar changes were observed in individuals with comorbidities, with prediabetes, and with prediabetes plus high CVD risk.The beneficial effects of semaglutide on cardiometabolic risk factors were consistent across all subgroups.Conclusions: This subgroup analysis confirms that semaglutide is effective in individuals with baseline BMI <35 and ≥35 kg/m 2 , including in those with comorbidities.

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Section: Discussionmentioning

confidence: 99%

Impact of BMI and comorbidities on efficacy of once‐weekly semaglutide: Post hoc analyses of the STEP 1 randomized trial

McGowan

Houshmand-Oeregaard

Laursen

et al. 2023

Obesity

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“…In addition to the previously confirmed cost-effectiveness of injectable semaglutide compared to dulaglutide ( Hu et al, 2022a ), our study further demonstrated a clear cost-effectiveness of its oral formulation. Studies in the US and Portugal have also confirmed the cost-effectiveness of oral semaglutide compared with dulaglutide ( Risebrough et al, 2021 ; Malkin et al, 2022 ). Moreover, our model predicted the cost-effectiveness of oral semaglutide compared with liraglutide, with the total incremental QALY (+0.02) consistent with that reported in the literature (0.01–0.07) ( Bain et al, 2020 ; Risebrough et al, 2021 ).…”

Section: Discussionmentioning

confidence: 89%

Cost-effectiveness analysis of once-daily oral semaglutide versus placebo and subcutaneous glucagon-like peptide-1 receptor agonists added to insulin in patients with type 2 diabetes in China

et al. 2023

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Introduction: Oral semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) that improves glycated hemoglobin levels and body weight in patients with type 2 diabetes (T2DM). We aim to evaluate the cost-effectiveness of once-daily oral semaglutide in comparison to placebo and injectable GLP-1 RAs in Chinese patients with T2DM inadequately controlled on basal insulin.Methods: The United Kingdom Prospective Diabetes Study Outcomes Model (UKPDS OM2.1) was used to estimate the cost-effectiveness by calculating the incremental cost-effectiveness ratio (ICER). Baseline characteristics of the simulation cohort were obtained from the PIONEER 8 trial. Utility and safety inputs were derived from a network meta-analysis of 12 trials. Direct medical costs were retrieved from published literature and discounted at an annual rate of 5%. We used a willingness-to-pay (WTP) threshold of $36,528.3 per quality-adjusted life-year (QALY) gained. Scenario analysis, and one-way and probabilistic sensitivity analysis were performed.Results: The effectiveness of oral semaglutide was 10.39 QALYs with a total cost of $30,223.10, while placebo provided 10.13 QALYs at a lower total cost of $20,039.19. Oral semaglutide was not cost-effective at an ICER of $39,853.22 and $88,776.61 per QALY compared to placebo and exenatide at the WTP. However, at an annual price of $1,871.9, it was cost-effective compared with dulaglutide, liraglutide, and lixisenatide. The model was most sensitive to the discount rate and annual cost of oral semaglutide. The price of oral semaglutide needed to be reduced to $1,711.03 per year to be cost-effective compared to placebo and other injectable GLP-1 RAs except for exenatide and semaglutide injection.Conclusion: We found that once-daily oral semaglutide, at a comparable price of semaglutide injection, proves to be a cost-effective add-on therapy to insulin for Chinese patients with T2DM, especially when compared to subcutaneous GLP-1 RAs other than injectable semaglutide and exenatide. However, to achieve cost-effectiveness in comparison to placebo, further cost reduction of oral semaglutide is necessary. The estimated annual cost of $1,711.03 for oral semaglutide demonstrates a more cost-effective option than placebo, highlighting its potential value in the management of T2DM.

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“…From the product-level perspective, semaglutide (oral or injectable) and empagliflozin were the most frequently used main comparators. Oral semaglutide was found to be cost effective in five of seven comparisons with empagliflozin [51,53,58,60,61,63,64] but was not cost effective in two comparisons [58,64]. Injectable semaglutide was found to be cost effective in all comparisons with empagliflozin [49,57,59] except one [59].…”

Section: Glp1 Compared With Sglt2mentioning

confidence: 93%

“…Explicit reasoning for the choice of risk equation was only present in a few cases. Three studies with SGLT2 as the main comparator cited model fit as the reason [40,45,56], while eight GLP1 studies cited advice from model proprietors as the reason [37,38,47,49,57,[61][62][63]. Different aspects of the risk equations were sometimes used simultaneously.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

A Systematic Review of Cost-Effectiveness Studies of Newer Non-Insulin Antidiabetic Drugs: Trends in Decision-Analytical Models for Modelling of Type 2 Diabetes Mellitus

Laursen

Jørgensen²,

Vestergaard

et al. 2023

PharmacoEconomics

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Background We performed a systematic overview of the cost-effectiveness analyses (CEAs) comparing non-insulin antidiabetic drugs (NIADs) with other NIADs for the treatment of type 2 diabetes mellitus (T2DM), using decision-analytical modelling (DAM), focusing on both the economic results and the underlying methodological choices. Methods Eligible studies were CEAs using DAM to compare NIADs within the glucagon-like peptide-1 (GLP1) receptor agonists, sodium-glucose cotransporter-2 (SGLT2) inhibitors, or dipeptidyl peptidase-4 (DPP4) inhibitor classes with other NIADs within those classes for the treatment of T2DM. The PubMed, Embase and Econlit databases were searched from 1 January 2018 to 15 November 2022. Two reviewers screened the studies for relevance by titles and abstracts and then for eligibility via full-text screening, extracted the data from the full texts and appendices, and then stored the data in a spreadsheet. ResultsThe search yielded 890 records and 50 studies were eligible for inclusion. The studies were mainly based on a European setting (60%). Industry sponsorship was found in 82% of studies. The CORE diabetes model was used in 48% of the studies. GLP1 and SGLT2 products were the main comparators in 31 and 16 studies, respectively, while one study had DPP4 and two had no easily discernible main comparator. Direct comparison between SGLT2 and GLP1 occurred in 19 studies. At a class level, SGLT2 dominated GLP1 in six studies and was cost effective against GLP1 once as part of a treatment pathway. GLP1 was cost effective in nine studies and not cost effective against SGLT2 in three studies. At a product level, oral and injectable semaglutide, and empagliflozin, were cost effective against other within-class products. Injectable and oral semaglutide were more frequently found cost effective in these comparisons, with some conflicting results. Most of the modelled cohorts and treatment effects were sourced from randomised controlled trials. The following model assumptions varied depending on the class of the main comparator: choice of and reasoning behind risk equations, the time until the treatment switch, and how often the comparators were discontinued. Diabetes-related complications were emphasised on par with quality-adjusted life-years as model outputs. The main quality issues were regarding the description of alternatives, the perspective of analysis, the measurement of costs and consequences, and patient subgroups. Conclusion The included CEAs using DAMs have limitations that hinder their ability to inform decision makers on the cost-effective choice: lack of updated reasoning behind the choice of key model assumptions, over-reliance on risk equations based on older treatment practices, and sponsorship bias. The question of which NIAD is cost effective for the treatment of which T2DM patient is a pressing one and the answer remains unclear. 1471 Cost-Effectiveness Studies Comparing Non-Insulin Pharmaceuticals for T2DM 2 Methods This systematic review was conducted in 2021, updated in 2022, a...

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

Cited by 6 publications

References 53 publications

Impact of BMI and comorbidities on efficacy of once‐weekly semaglutide: Post hoc analyses of the STEP 1 randomized trial

Impact of BMI and comorbidities on efficacy of once‐weekly semaglutide: Post hoc analyses of the STEP 1 randomized trial

Cost-effectiveness analysis of once-daily oral semaglutide versus placebo and subcutaneous glucagon-like peptide-1 receptor agonists added to insulin in patients with type 2 diabetes in China

A Systematic Review of Cost-Effectiveness Studies of Newer Non-Insulin Antidiabetic Drugs: Trends in Decision-Analytical Models for Modelling of Type 2 Diabetes Mellitus

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