Evaluation of the long‐term cost‐effectiveness of once‐weekly semaglutide versus dulaglutide for treatment of type 2 diabetes mellitus in the UK

Abstract

Aims Glucagon‐like peptide‐1 (GLP‐1) receptor agonists are appealing as glucose‐lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with low rates of hypoglycaemia. This analysis assessed the long‐term cost‐effectiveness of semaglutide 0.5 and 1 mg vs dulaglutide 1.5 mg (two once‐weekly GLP‐1 receptor agonists) from a UK healthcare payer perspective, based on the head‐to‐head SUSTAIN 7 trial, to inform healthcare decision making. Materials and Methods Long‐term outcomes were projected using the IQVIA CORE Diabetes Model (version 9.0). Baseline cohort characteristics, changes in physiological parameters and adverse event rates were derived from the 40‐week SUSTAIN 7 trial. Costs to a healthcare payer were assessed, and these captured pharmacy costs and costs of complications. Utilities were taken from published sources. Results Once‐weekly semaglutide 0.5 and 1 mg were associated with improvements in quality‐adjusted life expectancy of 0.04 and 0.10 quality‐adjusted life years, respectively, compared with dulaglutide 1.5 mg. Clinical benefits were achieved at reduced costs, with lifetime cost savings of GBP 35 with once‐weekly semaglutide 0.5 mg and GBP 106 with the once‐weekly semaglutide 1 mg, resulting from fewer diabetes‐related complications due to better glycaemic control. Therefore, both doses of once‐weekly semaglutide were considered dominant vs dulaglutide 1.5 mg (improving outcomes and reducing costs). Conclusions Compared with treatment with dulaglutide, once‐weekly semaglutide represents a cost‐effective option for treating individuals in the UK with T2DM who are not achieving glycaemic control with metformin, projected to both improve clinical outcomes and reduce costs.

A Relative Cost of Control Analysis of Once-Weekly Semaglutide Versus Exenatide Extended-Release, Dulaglutide and Liraglutide in the UK

“…Short-term cost-effectiveness analyses are intended to complement, rather than replace, long-term cost-effectiveness modelling, and can provide supportive evidence for the results of analyses that extrapolate over a longer time span. Our findings are similar to those of a previous long-term cost-effectiveness analysis of once-weekly semaglutide 1 mg versus dulaglutide 1.5 mg from a UK perspective, which found that once-weekly semaglutide 1 mg was associated with cost savings as well as improved outcomes [26].…”

“…The UK National Health Service (NHS) relies on value-based decisions to manage and allocate healthcare budgets and ensure that funded interventions represent good value for money [24,25]. In a recent long-term analysis, once-weekly semaglutide 1 mg was found to be cost-effective for the treatment of T2D in the UK, compared with dulaglutide 1.5 mg [26]. Short-term economic analyses, such as cost of control analyses, complement longer-term analyses and are useful to assess and easily compare the cost-effectiveness of multiple new treatments.…”

Cost-effectiveness of once-weekly semaglutide versus dulaglutide and lixisenatide in patients with type 2 diabetes with inadequate glycemic control in Sweden

“…In this analysis, there was a gain of 0.4 QALYs, in line with the 0.28 QALYs observed in our analysis in the Swedish setting. In the UK analysis 49 , in which the IQVIA CORE Diabetes Model was used, gains of 0.17 QALYs were observed with once-weekly semaglutide vs dulaglutide. All three analyses (in the Swedish, Canadian, and UK settings) show that once-weekly semaglutide remains dominant vs dulaglutide.…”

Oral Semaglutide Versus Empagliflozin, Sitagliptin and Liraglutide in the UK: Long-Term Cost-Effectiveness Analyses Based on the PIONEER Clinical Trial Programme

“…Glucagon-like peptide-1 (GLP-1) receptor agonists represent a highly efficacious class of interventions for the treatment of type 2 diabetes, with the injectable GLP-1 analogue onceweekly semaglutide shown to be both efficacious and cost-effective versus a variety of therapies [8][9][10][11]. However, until recently, GLP-1 receptor agonists have only been available in injectable formulations, which may have been a barrier to patient use compared with other modern treatment options such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors, which are administered orally.…”

“…Indeed, in the UK, injectable GLP-1 receptor agonists are only recommended as an intensification step for patients with inadequate glycaemic control following a triple therapy combination of metformin plus a DPP-4 inhibitor with a sulfonylurea, pioglitazone or an SGLT2 inhibitor, for whom insulin therapy would have significant occupational implications or weight loss would benefit other obesity-related comorbidities [6]. Given the efficacy benefits GLP-1 receptor agonists appear to offer, earlier intensification to such medications could overcome the documented and substantial therapeutic inertia in people with type 2 diabetes [8][9][10][11][12].…”