Evaluating the Long-Term Cost-Effectiveness of Once-Weekly Semaglutide Versus Once-Daily Liraglutide for the Treatment of Type 2 Diabetes in the UK

Abstract

Introduction: Once-weekly semaglutide 1 mg is a novel glucagon-like peptide-1 receptor agonist (GLP-1 RA) for the treatment of type 2 diabetes that has demonstrated significantly greater reductions in glycated haemoglobin (HbA1c) and body weight than the GLP-1 RA once-daily liraglutide 1.2 mg in the SUSTAIN 10 trial. The present analysis aimed to evaluate the longterm cost-effectiveness of once-weekly semaglutide 1 mg versus once-daily liraglutide 1.2 mg from a UK healthcare payer perspective. Methods: Long-term outcomes were projected using the IQVIA CORE Diabetes Model (version 9.0), with baseline characteristics and treatment effects sourced from SUSTAIN 10. Patients were assumed to initiate treatment with GLP-1 RAs and continue treatment until HbA1c exceeded 7.5%, at which point GLP-1 RAs were discontinued and basal insulin was initiated. Pharmacy costs and costs of complications were measured in 2018 pounds sterling (GBP), with future costs and outcomes discounted at 3.5% per annum. Utilities were taken from published sources. Results: In the base-case analysis, once-weekly semaglutide 1 mg was associated with an increase in discounted life expectancy of 0.21 years and discounted quality-adjusted life expectancy of 0.30 quality-adjusted life-years, compared with once-daily liraglutide 1.2 mg. Clinical benefits were achieved at reduced costs, with lifetime cost savings of GBP 140 per patient with semaglutide versus liraglutide, owing to a reduction in diabetes-related complications, in particular cardiovascular disease (mean cost saving of GBP 279 per patient). Therefore, once-weekly semaglutide 1 mg was dominant compared with once-daily liraglutide 1.2 mg. The results of the sensitivity analyses were similar, demonstrating the robustness of the base-case analysis. Conclusions: Once-weekly semaglutide 1 mg is a cost-effective treatment option versus oncedaily liraglutide 1.2 mg, based on the SUSTAIN 10 trial, from a UK healthcare payer perspective.

Evaluating the Cost-Effectiveness of Once-Weekly Semaglutide 1 mg Versus Empagliflozin 25 mg for Treatment of Patients with Type 2 Diabetes in the UK Setting

“…The analysis was consistent with previously published cost-effectiveness analyses in the UK setting [ 10 , 11 ]. A lifetime time horizon was used, as recommended in modelling guidelines for the UK released by NICE, to ensure that all differences in long-term complications (and their impact on costs and quality of life) and mortality with once-weekly semaglutide 1 mg and empagliflozin 25 mg were captured [ 12 ].…”

“…Therefore both doses of once-weekly semaglutide were considered dominant. More recently, once-weekly semaglutide 1 mg was compared with liraglutide 1.2 mg based on the SUSTAIN 10 randomized controlled trial [ 10 ]. This analysis also found that once-weekly semaglutide 1 mg was associated with improved clinical outcomes and cost savings compared with liraglutide 1.2 mg, and therefore was found to be dominant.…”

“…The analysis aimed to take a single clinical approach, with glycaemic control declining over time, with subsequent addition of insulin therapy and a consequent reduction in HbA 1c accompanied by an increase in BMI and risk of hypoglycaemia. This approach has been used in peer-reviewed cost-effectiveness analyses, and in the NICE multiple technology appraisal of SGLT2 inhibitors [ 10 , 11 , 29 ]. The intention behind using this approach was to ensure that the analysis reflects clinical practice and is therefore relevant to healthcare decision makers.…”

“…Unit costs of diabetes medications were taken from the Monthly Index of Medical Specialities (MIMS) database, and were used to calculate annual pharmacy costs with once-weekly semaglutide 1 mg, empagliflozin 25 mg and basal insulin (assumed 40 IU based on the defined daily dose) [18,19]. Costs of complications and patient management were consistent with previously published cost-effectiveness analyses for the UK setting, with costs taken from published sources and inflated to 2019 values where appropriate (Table 2) [10,20].…”

Exploring the Appropriate Price of Semaglutide for Type 2 Diabetes Patients Based on Cost-Utility Analysis in China

“… Hansen et al (2020) identified that when two glycaemic lowering goals, HbA1c ≤ 6.5% and HbA1c < 7.0%, are reached, the cost of other subcutaneous injections of GLP-1 receptor agonists is higher than that of semaglutide. Johansen et al (2020) indicated that compared with once-daily liraglutide 1.2 mg, the life expectancy with once-weekly semaglutide 1 mg increased by 0.21 years, and the quality-adjusted life expectancy increased by 0.3 years. In terms of long-term or short-term cost-effectiveness, the choice of semaglutide to treat T2D is significantly better than that of other antihyperglycaemic drugs.…”