The Cost-effectiveness of Subcutaneous Semaglutide 2.4 mg Injection for Chronic Weight Management in Canada: A Societal Perspective

Abstract

OBJECTIVES: This study assessed the cost-effectiveness of once-weekly semaglutide 2.4mg injection as adjunct to reduced-calorie meals and increased physical activity (diet and exercise, D&E), in adult patients with obesity (body mass index [BMI] of ≥30 kg/m2) or overweight (BMI 27-30 kg/m2) in the presence of ≥1 weight-related comorbidity, by comparing it with D&E alone or D&E in combination with liraglutide 3.0mg, orlistat, or naltrexone 32mg/bupropion (NB32). METHODS: The safety and efficacy of semaglutide 2.4mg and D&E were sourced from the STEP 1 and STEP 2 trials, while a network meta-analysis informed the relative efficacy vs. other comparators. The Core Obesity Model was used to extrapolate costs and health outcomes (both discounted at 1.5% annually) over 40 years for a cohort with starting age 50 years and starting BMI 37.5 kg/m2, taking D&E alone or in combination with other pharmacotherapies for 1 year. Costs were analyzed from a societal perspective, including publicly and privately funded health expenses, patient co-payments, and indirect costs. RESULTS: Semaglutide 2.4mg reduced weight and reverted prediabetes prevalence more than alternative therapies. This translated into delays in the occurrence of weight-related complications, and gains in life-expectancy between 0.081 years vs. D&E (maximum gain) and 0.030 years vs. liraglutide 3.0mg (minimum gain), and quality-adjusted life-years (QALYs) between 0.103 vs. D&E and 0.039 vs. liraglutide 3.0mg, at additional costs. The incremental cost-utility ratios were 29,677 Canadian dollars (CAD)/QALY gained vs. D&E, CAD12,369/QALY gained vs. liraglutide 3.0mg, CAD25,663/QALY gained vs. orlistat and CAD25,003/QALY gained vs. NB32. The cost-effectiveness acceptability curve showed a high likelihood of subcutaneous semaglutide 2.4 mg injection being considered cost-effective, at willingness-to-pay thresholds of CAD50,000/QALY and beyond. CONCLUSION: Based on this analysis, the use of semaglutide 2.4mg injection can be considered a cost-effective alternative compared with D&E alone, or D&E in combination with other pharmacotherapies.