Long-Term Cost Effectiveness of Oral Semaglutide Versus Empagliflozin and Sitagliptin for the Treatment of Type 2 Diabetes in the Swedish Setting

Abstract

Objective The aim of this study was to assess the cost effectiveness of oral semaglutide versus other oral glucose-lowering drugs for the management of type 2 diabetes (T2D) in Sweden. Methods The Swedish Institute for Health Economics Diabetes Cohort Model was used to assess the cost effectiveness of oral semaglutide 14 mg versus empagliflozin 25 mg and oral semaglutide 14 mg versus sitagliptin 100 mg, using data from the head-to-head PIONEER 2 and 3 trials, respectively, in which these treatments were added to metformin (± sulphonylurea). Base-case and scenario analyses were conducted. Robustness was evaluated with deterministic and probabilistic sensitivity analyses. Results In the base-case analyses, greater initial lowering of glycated haemoglobin levels with oral semaglutide versus empagliflozin and oral semaglutide versus sitagliptin, respectively, resulted in reduced incidences of micro-and macrovascular complications and was associated with lower costs of complications and indirect costs. Treatment costs were higher for oral semaglutide, resulting in higher total lifetime costs than with empagliflozin (Swedish Krona [SEK] 1,245,570 vs. 1,210,172) and sitagliptin (SEK1,405,789 vs. 1,377,381). Oral semaglutide was shown to be cost effective, with an incremental cost-effectiveness ratio (ICER) of SEK239,001 per quality-adjusted life-year (QALY) compared with empagliflozin and SEK120,848 per QALY compared with sitagliptin, from a payer perspective. ICERs were lower at SEK191,721 per QALY compared with empagliflozin and SEK95,234 per QALY compared with sitagliptin from a societal perspective. Results were similar in scenario analyses that incorporated cardiovascular effects, and also in sensitivity analyses. Conclusions In a Swedish setting, oral semaglutide was cost effective compared with empagliflozin and sitagliptin for patients with T2D inadequately controlled on oral glucose-lowering drugs.

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][49][50] [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][52][53][54].…”

“…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.…”

The challenges and pitfalls of incorporating evidence from cardiovascular outcomes trials in health economic modelling of type 2 diabetes

“…Several long‐term diabetes modelling studies have included data from CVOTs in cost‐effectiveness analyses aiming to compare active interventions from multiple CVOTs. These studies provide examples of the different methodologies possible for incorporating data from CVOTs into current modelling approaches for type 2 diabetes, and include long‐term cost‐effectiveness analyses of: Liraglutide versus empagliflozin and oral semaglutide versus empagliflozin in the United Kingdom (both Ramos et al, 2020); 58,59 Liraglutide versus empagliflozin in Denmark (Ehlers et al, 2021); 60 Sitagliptin versus empagliflozin in the United States (Reifsnider et al, 2021); 61 Liraglutide versus empagliflozin in the United States (Reifsnider et al, 2022); 62 Oral semaglutide versus empagliflozin and sitagliptin in Sweden (Eliasson et al, 2022) and the United States (Institute for Clinical and Economic Review, 2019); 56,63 A 2022 update of the type 2 diabetes guidelines by NICE in the United Kingdom 57 …”