Oral semaglutide versus injectable glucagon-like peptide-1 receptor agonists: a cost of control analysis

Abstract

Aims:The efficacy and safety of oral semaglutide, the first glucagon-like peptide-1 (GLP-1) receptor agonist developed for oral administration for the treatment of type 2 diabetes, was evaluated in the PIONEER clinical trial program, and a recently published network meta-analysis allowed comparison with further injectable GLP-1 receptor agonists. The present study aimed to assess the short-term costeffectiveness of oral semaglutide 14 mg versus subcutaneous once-weekly dulaglutide 1.5 mg, onceweekly exenatide 2 mg, twice-daily exenatide 10 mg, once-daily liraglutide 1.8 mg, once-daily lixisenatide 20 mg, and once-weekly semaglutide 1 mg, in terms of the cost per patient achieving glycated hemoglobin (HbA1c) targets (cost of control). Materials and methods: Cost of control was calculated by dividing the annual treatment costs associated with an intervention by the proportion of patients achieving the treatment target with an intervention, with outcomes calculated for targets of HbA1c 6.5% and HbA1c <7.0% for all included GLP-1 receptor agonists. Annual treatment costs were accounted in 2019 United States dollars (USD), based on 2019 wholesale acquisition cost. Results: For the treatment target of HbA1c 6.5%, once-weekly semaglutide 1 mg and oral semaglutide 14 mg were associated with the lowest costs of control, at USD 15,430 and USD 17,383 per patient achieving target, respectively. Similarly, the cost of control was lowest with once-weekly semaglutide 1 mg at USD 12,627 per patient achieving target, followed by oral semaglutide 14 mg at USD 13,493 per patient achieving target for the target of HbA1c <7.0%. All other interventions were associated with higher cost of control values for both targets. Conclusions: Oral semaglutide 14 mg is likely to be cost-effective versus dulaglutide, exenatide (once weekly and twice daily), liraglutide, and lixisenatide in terms of bringing people with type 2 diabetes to glycemic control targets of HbA1c 6.5% and HbA1c <7.0% in the US. ARTICLE HISTORY

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

“…Furthermore, a long-term cost-effectiveness analysis demonstrated that oral semaglutide was more cost effective than empagliflozin, sitagliptin, and liraglutide for patients with T2D in the United Kingdom ( Bain et al, 2020 ). 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.…”

Efficacy of Semaglutide in a Subcutaneous and an Oral Formulation

“…The relative cost-effectiveness of the two semaglutide formulations has not been directly compared. However, both subcutaneous and oral semaglutide have been reported to be more costeffective and offer lower cost-of-control compared with other injectable GLP-1RAs and oral glucose-lowering drugs, although this may vary between different patient cohorts and healthcare settings (58)(59)(60)(61)(62)(63)(64). In addition, switching may be dependent on non-medical decisions outwith the physician's choice, with a recent expert consensus indicating that non-medical triggers for switching to subcutaneous semaglutide from other GLP-1RAs also included formulary changes and insurance mandates, as well as cost considerations (65).…”

A Review on Semaglutide: An Oral Glucagon-Like Peptide 1 Receptor Agonist in Management of Type 2 Diabetes Mellitus

“…In a cost of control analysis by Hansen et al for the US market, orally administered semaglutide was found to be cost effective in comparison to dulaglutide, exenatide, liraglutide and lixisenatide. Cost of a 14 mg dose of orally administered semaglutide came out the least at USD 15,430 and USD 17,383 for patients achieving glycaemic targets of < 7% and ≤ 6.5%, respectively [ 46 ]. In another cost-effectiveness analysis done for the UK market, orally administered semaglutide 14 mg was found to be cost effective relative to sitagliptin 100 mg and empagliflozin 25 mg and dominant in comparison to liraglutide 1.8 mg daily dose for the treatment of T2DM.…”