The long-term cost-effectiveness of once-weekly semaglutide 1 mg vs. dulaglutide 3 mg and 4.5 mg in the UK

Abstract

Aims Once-weekly semaglutide and dulaglutide represent two highly efficacious treatment options for type 2 diabetes. A recent indirect treatment comparison (ITC) has associated semaglutide 1 mg with similar and greater improvements in glycated haemoglobin (HbA1c) and body weight, respectively, vs. dulaglutide 3 mg and 4.5 mg. The present study aimed to evaluate the long-term cost-effectiveness of semaglutide 1 mg vs. dulaglutide 3 mg and 4.5 mg in the UK. Materials and methods The IQVIA CORE Diabetes Model (v9.0) was used to project outcomes over patients’ lifetimes. Baseline cohort characteristics were sourced from SUSTAIN 7, with changes in HbA1c and body mass index applied as per the ITC. Modelled patients received semaglutide or dulaglutide for 3 years, after which treatment was intensified to basal insulin. Costs (expressed in 2020 pounds sterling [GBP]) were accounted from a healthcare payer perspective. Results Semaglutide 1 mg was associated with improvements in quality-adjusted life expectancy of 0.05 and 0.04 quality-adjusted life years (QALYs) vs. dulaglutide 3 mg and 4.5 mg, respectively, due to a reduced incidence of diabetes-related complications with semaglutide. Direct costs were estimated to be GBP 76 lower and GBP 8 higher in the comparisons with dulaglutide 3 mg and 4.5 mg, respectively. Overall outcomes were similar, but favoured semaglutide, and based on modelled mean outcomes it was considered dominant vs. dulaglutide 3 mg and associated with an incremental cost-effectiveness ratio of GBP 228 per QALY gained vs. dulaglutide 4.5 mg. Conclusions Semaglutide 1 mg represents a cost-effective treatment vs. dulaglutide 3 mg and 4.5 mg for type 2 diabetes from a healthcare payer perspective in the UK.

A Systematic Review of Cost-Effectiveness Studies of Newer Non-Insulin Antidiabetic Drugs: Trends in Decision-Analytical Models for Modelling of Type 2 Diabetes Mellitus

“…The results of extracted data from included studies can be found in Table 1, which summarises the general characteristics of the studies. The majority of studies (n = 30) were conducted in Europe , of which many were conducted in the UK (n = 9) [37,38,40,45,46,48,51,57,62], and one-third of the studies were conducted in North America (n = 10) [64][65][66][67][68][69][70][71][72][73] and Asia (n = 8) [74][75][76][77][78][79][80][81]. Two studies were conducted outside these regions: one each from Colombia [82] and Iran [83].…”

“…Explicit reasoning for the choice of risk equation was only present in a few cases. Three studies with SGLT2 as the main comparator cited model fit as the reason [40,45,56], while eight GLP1 studies cited advice from model proprietors as the reason [37,38,47,49,57,[61][62][63]. Different aspects of the risk equations were sometimes used simultaneously.…”

Early use of oral semaglutide in the UK: A cost-effectiveness analysis versus continuing metformin and SGLT-2 inhibitor therapy

“…23 Similar analyses have evaluated the long-term cost-effectiveness of oral semaglutide versus empagliflozin and dulaglutide in Portugal, and one time per week injectable semaglutide versus high-dose dulaglutide and liraglutide in the UK. [24][25][26] However, questions remain over the impact of introducing oral semaglutide versus continuing therapy with the oral agents recommended by NICE, specifically metformin plus an SGLT-2 inhibitor, and the present study aimed to build on these previous analyses to address this pertinent research question using similar methodology.…”