The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

Ehlers, Lars Holger; Lamotte, M; Ramos, Mafalda; Sandgaard, Susanne; Holmgaard, Pia; Frary, Evan C.; Ejskjær, Niels

doi:10.2217/cer-2021-0169

Cited by 11 publications

(22 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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 ].…”

Section: Discussionsupporting

confidence: 86%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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 – 54 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Malkin¹,

Carvalho

Costa³

et al. 2022

Diabetol Metab Syndr

View full text Add to dashboard Cite

Background Oral semaglutide is a novel glucagon-like peptide-1 (GLP-1) analog that has been associated with improvements in glycated hemoglobin (HbA1c) and body weight versus sodium-glucose cotransporter-2 inhibitor empagliflozin and injectable GLP-1 receptor agonist dulaglutide in the PIONEER 2 clinical trial and in a recent network meta-analysis (NMA), respectively. The aim of the present study was to evaluate the long-term cost-effectiveness of oral semaglutide 14 mg versus empagliflozin 25 mg and dulaglutide 1.5 mg for the treatment of type 2 diabetes from a healthcare payer perspective in Portugal. Methods In two separate analyses, outcomes were projected over patients’ lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 4% per annum. Clinical data were sourced from the PIONEER 2 trial and the NMA for the comparisons versus empagliflozin and dulaglutide, respectively. Patients were assumed to receive initial therapies until HbA1c exceeded 7.5%, then treatment-intensified to solely basal insulin therapy. Costs were accounted from a National Healthcare Service perspective in Portugal and expressed in 2021 euros (EUR). Utilities were taken from published sources. Results Oral semaglutide 14 mg was associated with improvements in life expectancy of 0.10 and 0.03 years, and quality-adjusted life expectancy of 0.11 and 0.03 quality-adjusted life years (QALYs), versus empagliflozin 25 mg and dulaglutide 1.5 mg, respectively. Improved clinical outcomes were due to a reduced cumulative incidence and increased time to onset of diabetes-related complications with oral semaglutide. Total costs were projected to be EUR 2548 and EUR 814 higher with oral semaglutide versus empagliflozin and dulaglutide, with higher acquisition costs partially offset by cost savings from avoidance of diabetes-related complications. Oral semaglutide 14 mg was therefore associated with incremental cost-effectiveness ratios of EUR 23,571 and EUR 23,927 per QALY gained versus empagliflozin 25 mg and dulaglutide 1.5 mg, respectively. Conclusions Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, oral semaglutide 14 mg was considered cost-effective versus empagliflozin 25 mg and dulaglutide 1.5 mg for the treatment of type 2 diabetes in Portugal.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Malkin¹,

Carvalho

Costa³

et al. 2022

Diabetol Metab Syndr

View full text Add to dashboard Cite

show abstract

“…The subjects were uncontrolled T2DM patients with metformin alone [17]. As a result, price/day was 25.53 vs 11.40 by Danish Krone (DKK), respectively.…”

mentioning

confidence: 99%

Useful Oral Administration of Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA) as Semaglutide (Rybelsus) for Type 2 Diabetes Mellitus (T2DM)

Bando

2022

Asp Biomed Clin Case Rep

View full text Add to dashboard Cite

As recommended pharmacological agents for type 2 diabetes mellitus (T2DM), Glucagon-Like Peptide 1 receptor agonist (GLP-1Ra) is highly evaluated for its various beneficial effects. Among them, semaglutide (Rybelsus) has been in focus for useful oral formation with useful oral hypoglycemic agent (OHA). Administration per os is possible due to the developed technique of absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate. Clinical efficacy was shown by a series of Peptide Innovation for Early Diabetes Treatment (PIONEER) with enough weight reduction and decreased HbA1c. From the results of several PIONEER programs, oral semaglutide 14 mg/day had reduced HbA1c values by approximately 1.0-1.4%.

show abstract

“…Studies evaluating short term (3-5 years) budget impact of empagliflozin as add-on to SoC for the treatment of T2D with a history of CVD and/or increased risk of CVD from, for example, Greece, 18 Italy, 19 the UK 20 and South Africa, 21 have indicated both clinical benefits and cost savings. Other studies from the UK, 22,23 Greece 24 and the United States 25 have concluded that empagliflozin is costeffective in people with T2D and eCVD compared with SoC, or to comparator products such as semaglutide, 26 dapagliflozin, 27 sitagliptin 25 and liraglutide. 28 Support for implementation of empagliflozin was also found in a Swedish 5-year budget impact study based on register data of 5500 people with T2D and eCVD, which estimated a cost per quality-adjusted life year (QALY) of 8100 euros (EUR).…”

mentioning

confidence: 99%

Model‐based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease

Nilsson

Andersson

Persson

et al. 2022

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim To perform a model‐based analysis of the short‐ and long‐term health benefits and costs of further increased implementation of empagliflozin for people with type 2 diabetes and established cardiovascular disease (eCVD) in Sweden. Materials and Methods The validated Institute for Health Economics Diabetes Cohort Model (IHE‐DCM) was used to estimate health benefits and a 3‐year budget impact, and lifetime costs per quality‐adjusted life years (QALY) gained of increased implementation of adding empagliflozin to standard of care (SoC) for people with type 2 diabetes and eCVD in a Swedish setting. Scenarios with 100%/75%/50% implementation were explored. Analyses were based on 30 model cohorts with type 2 diabetes and eCVD (n = 131 412 at baseline) from national health data registers. Sensitivity analyses explored the robustness of results. Results Over 3 years, SoC with empagliflozin (100% implementation) versus SoC before empagliflozin resulted in 7700 total life years gained and reductions in cumulative incidence of cardiovascular deaths by 30% and heart failures by 28%. Annual costs increased by 15% from higher treatment costs and increased survival. Half of these benefits and costs are not yet reached with current implementation below 50%. SoC with empagliflozin yielded 0.37 QALYs per person, with an incremental cost‐effectiveness ratio of 16 000 EUR per QALY versus SoC before empagliflozin. Conclusions Model simulations using real‐world data and trial treatment effects indicated that a broader implementation of empagliflozin, in line with current guidelines for treatment of people with type 2 diabetes and eCVD, would lead to further benefits even from a short‐term perspective.

show abstract

The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

Cited by 11 publications

References 15 publications

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

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

Useful Oral Administration of Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA) as Semaglutide (Rybelsus) for Type 2 Diabetes Mellitus (T2DM)

Model‐based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease

Contact Info

Product

Resources

About