RESUMO
OBJECTIVE: Obesity presents an enduring and multifaceted dilemma that impacts individuals, society, economies, and healthcare systems alike. Glucagon-like peptide-1 (GLP-1) receptor agonists, including liraglutide and semaglutide, have received FDA approval for obesity treatment. This study aims to present a cost-effectiveness analysis to compare the cost and clinical outcomes of semaglutide vs. liraglutide on weight loss in people with overweight and obesity. MATERIALS AND METHODS: A cost-effectiveness analysis was conducted to compare the cost and the clinical outcomes of adding weekly 2.4 mg SC semaglutide vs. daily 3.0 mg SC liraglutide or placebo to physical activity and diet control in overweight and obese patients. A clinical outcome of achieving ≥15% weight loss was chosen. A simple decision analysis model from a third-payer perspective was applied. Drug costs were based on the retail price of the USA market. One-way sensitivity analyses were performed. RESULTS: Results showed that 2.4 mg weekly semaglutide, when added to physical activity and diet control, was the most cost-effective choice in terms of ≥15% weight loss (ICER: $ 7,056/patient/68 weeks). The model was robust against the 50% increase in the unit cost of semaglutide and the 50% decrease in the unit cost of liraglutide, as well as the changes in probabilities by the corresponding 95% confidence intervals across the model. CONCLUSIONS: This cost-effectiveness analysis suggests that employing once-weekly 2.4 mg semaglutide emerges as a remarkably cost-effective option when contrasted with once-daily 3.0 mg liraglutide in patients with overweight and obesity when added to physical activity and diet control.
Assuntos
Análise Custo-Benefício, Peptídeos Semelhantes ao Glucagon, Liraglutida, Obesidade, Sobrepeso, Humanos, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Liraglutida/administração & dosagem, Liraglutida/economia, Liraglutida/uso terapêutico, Obesidade/tratamento farmacológico, Obesidade/economia, Sobrepeso/tratamento farmacológico, Sobrepeso/economia, Injeções Subcutâneas, Técnicas de Apoio para a Decisão, Redução de Peso/efeitos dos fármacos, Esquema de Medicação, Fármacos Antiobesidade/economia, Fármacos Antiobesidade/administração & dosagem, Fármacos Antiobesidade/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/uso terapêutico, Análise de Custo-EfetividadeRESUMO
OBJECTIVES: This study aimed to assess the cost-effectiveness of weight-management pharmacotherapies approved by Canada Health, i.e., orlistat, naltrexone 32 mg/bupropion 360 mg (NB-32), liraglutide 3.0 mg and semaglutide 2.4 mg as compared to the current standard of care (SoC). METHODS: Analyses were conducted using a cohort with a mean starting age 50 years, body mass index (BMI) 37.5 kg/m2, and 27.6% having type 2 diabetes. Using treatment-specific changes in surrogate endpoints from the STEP trials (BMI, glycemic, blood pressure, lipids), besides a network meta-analysis, the occurrence of weight-related complications, costs, and quality-adjusted life-years (QALYs) were projected over lifetime. RESULTS: From a societal perspective, at a willingness-to-pay (WTP) threshold of CAD 50 000 per QALY, semaglutide 2.4 mg was the most cost-effective treatment, at an incremental cost-utility ratio (ICUR) of CAD 31 243 and CAD 29 014 per QALY gained versus the next best alternative, i.e., orlistat, and SoC, respectively. Semaglutide 2.4 mg extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg and remained cost-effective both under a public and private payer perspective. Results were robust to sensitivity analyses varying post-treatment catch-up rates, longer treatment durations and using real-world cohort characteristics. Semaglutide 2.4 mg was the preferred intervention, with a likelihood of 70% at a WTP threshold of CAD 50 000 per QALY gained. However, when the modeled benefits of weight-loss on cancer, mortality, cardiovascular disease (CVD) or osteoarthritis surgeries were removed simultaneously, orlistat emerged as the best value for money compared with SoC, with an ICUR of CAD 35 723 per QALY gained. CONCLUSION: Semaglutide 2.4 mg was the most cost-effective treatment alternative compared with D&E or orlistat alone, and extendedly dominated other pharmacotherapies such as NB-32 or liraglutide 3.0 mg. Results were sensitive to the inclusion of the combined benefits of mortality, cancer, CVD, and knee osteoarthritis.
Assuntos
Fármacos Antiobesidade, Análise Custo-Benefício, Obesidade, Orlistate, Humanos, Canadá, Pessoa de Meia-Idade, Obesidade/tratamento farmacológico, Obesidade/economia, Feminino, Fármacos Antiobesidade/uso terapêutico, Fármacos Antiobesidade/economia, Masculino, Orlistate/uso terapêutico, Anos de Vida Ajustados por Qualidade de Vida, Liraglutida/uso terapêutico, Liraglutida/economia, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/economia, Bupropiona/uso terapêutico, Bupropiona/economia, Naltrexona/uso terapêutico, Naltrexona/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Peptídeos Semelhantes ao Glucagon/economiaAssuntos
Custos de Medicamentos, Desenvolvimento de Medicamentos, Peptídeos Semelhantes ao Glucagon, Obesidade, Humanos, Desenvolvimento de Medicamentos/economia, Desenvolvimento de Medicamentos/tendências, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Obesidade/tratamento farmacológicoRESUMO
INTRODUCTION: Novel glucagon-like peptide-1 (GLP-1) receptor agonist oral semaglutide has demonstrated greater improvements in glycated hemoglobin (HbA1c) and body weight versus oral medications empagliflozin and sitagliptin, and injectable GLP-1 analog liraglutide, in the PIONEER clinical trial program. Based on these data, the present analysis aimed to evaluate the long-term cost-effectiveness of oral semaglutide versus empagliflozin, sitagliptin and liraglutide in Spain. METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 3.0% annually. Cohort characteristics and treatment effects were sourced from PIONEER 2 and 4 for the comparisons of oral semaglutide 14 mg versus empagliflozin 25 mg and liraglutide 1.8 mg, respectively, and PIONEER 3 for oral semaglutide 7 and 14 mg versus sitagliptin 100 mg. Costs were accounted from a healthcare payer perspective in 2020 euros (EUR). Patients were assumed to receive initial therapies until HbA1c exceeded 7.5% and then treatment-intensified to basal insulin. RESULTS: Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.13, 0.19 and 0.06 quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with direct costs EUR 168 higher versus empagliflozin and EUR 236 and 1415 lower versus sitagliptin and liraglutide, respectively. Oral semaglutide 14 mg was associated with an incremental cost-effectiveness ratio (ICER) of EUR 1339 per QALY gained versus empagliflozin and was considered dominant (clinically superior and cost saving) versus sitagliptin and liraglutide. Additional analyses demonstrated that oral semaglutide 7 mg was associated with improvements of 0.11 QALYs and increased costs of EUR 226 versus sitagliptin and was therefore associated with an ICER of EUR 2011 per QALY gained. CONCLUSION: Oral semaglutide 14 mg was dominant versus sitagliptin and liraglutide, and cost-effective versus empagliflozin, for the treatment of type 2 diabetes in Spain.
Assuntos
Diabetes Mellitus Tipo 2, Peptídeos Semelhantes ao Glucagon, Hipoglicemiantes, Administração Oral, Compostos Benzidrílicos/uso terapêutico, Ensaios Clínicos como Assunto, Análise Custo-Benefício, Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Glucosídeos/uso terapêutico, Hemoglobinas Glicadas/análise, Humanos, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Liraglutida/uso terapêutico, Fosfato de Sitagliptina/uso terapêutico, EspanhaRESUMO
BACKGROUND: Oral semaglutide is the first orally administered glucagon-like peptide-1 receptor agonist (GLP-1RA) approved by the FDA. Clinical trials found that oral semaglutide 14 mg had a greater reduction in hemoglobin A1c (A1c) compared with empagliflozin 25 mg and sitagliptin 100 mg and was noninferior to liraglutide 1.8 mg. However, US cost-effectiveness data for oral semaglutide are limited and do not consider the costs of adverse events. OBJECTIVE: To assess the short-term cost-effectiveness of oral semaglutide compared with empagliflozin, sitagliptin, and liraglutide in patients with type 2 diabetes. METHODS: A decision analysis over a 52-week time horizon was used to evaluate the incremental cost-effectiveness of oral semaglutide vs empagliflozin, sitagliptin, and liraglutide from a US health care payer's perspective. Data on efficacy, adverse events, and discontinuation were derived from 52-week data from phase 3, head-to-head clinical trials (PIONEER 2, 3, and 4). Costs included drug and administration cost and treatment of gastrointestinal adverse events. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in cost over the difference in A1c reduction between oral semaglutide and comparators. RESULTS: In the base-case analysis, 52-week treatment costs with oral semaglutide were $2,660 and $3,104 higher and $2,337 less than empagliflozin, sitagliptin, and liraglutide, respectively. Incremental (greater) A1c reductions were seen with oral semaglutide at 0.40%, 0.50%, and 0.30% vs empagliflozin, sitagliptin, and liraglutide, respectively. ICERs per 1% reduction in A1c for oral semaglutide were $6,650 and $6,207 vs empagliflozin and sitagliptin, respectively. Oral semaglutide was dominant vs liraglutide (ICER of -$7,790). CONCLUSIONS: Oral semaglutide was dominant relative to liraglutide, offering a cost-saving GLP-1RA oral alternative. While there is not a recognized willingness-to-pay threshold for a 1% reduction in A1c, oral semaglutide may be cost-effective relative to empagliflozin and sitagliptin if a decision maker's willingness-to-pay threshold exceeds $6,650 and $6,207, respectively. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Custos de Medicamentos, Peptídeos Semelhantes ao Glucagon/economia, Administração Oral, Compostos Benzidrílicos/administração & dosagem, Compostos Benzidrílicos/economia, Análise Custo-Benefício, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Glucosídeos/administração & dosagem, Glucosídeos/economia, Humanos, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/economia, Liraglutida/administração & dosagem, Liraglutida/economia, Fosfato de Sitagliptina/administração & dosagem, Fosfato de Sitagliptina/economia, Estados UnidosRESUMO
BACKGROUND: Oral semaglutide is the first oral formulation of a glucagon-like peptide 1 (GLP-1) receptor agonist to be approved in the United States for glycemic control in people with type 2 diabetes mellitus (T2DM). While oral semaglutide is not indicated for reduction of cardiovascular event risk, its label does include evidence of no increase in cardiovascular risk in people who received oral semaglutide. OBJECTIVE: To estimate the incremental value of oral semaglutide added to existing antihyperglycemic treatment for people with T2DM with additional risk for cardiovascular disease. METHODS: We estimated the lifetime cost-effectiveness of oral semaglutide added to current antihyperglycemic treatment for T2DM using a microsimulation model based primarily on the UK Prospective Diabetes Study (UKPDS) Outcomes Model 2 (OM2) equations. Oral semaglutide added to current antihyperglycemic treatment was separately compared with (a) ongoing background antihyperglycemic treatment, (b) sitagliptin, (c) empagliflozin, and (d) liraglutide. Comparators sitagliptin, empagliflozin, and liraglutide were added to ongoing antihyperglycemic treatment. We applied hazard ratios derived from a network meta-analysis for cardiovascular and renal outcomes to the UKPDS OM2 estimated baseline rates. Health state utilities and costs were derived from the published literature. We estimated total costs, life-years (LYs), quality-adjusted life-years (QALYs), clinical events, and cost per major adverse cardiovascular event (MACE) avoided, over a lifetime time horizon using discount rates of 3% for costs and outcomes. RESULTS: The lifetime total cost for people treated with oral semaglutide was $311,300, with costs for the other comparators ranging from $262,800 (background treatment alone) to $287,800 (liraglutide). Oral semaglutide resulted in the fewest MACE, including the fewest cardiovascular deaths. Among the 5 modeled treatment strategies, oral semaglutide had the highest LYs gained (8.43 vs. 7.76 [background treatment alone] to 8.29 [empagliflozin and liraglutide]) and the highest QALYs gained (4.11 vs. 3.70 [background treatment alone] to 4.03 [empagliflozin]). Oral semaglutide would likely be considered cost-effective compared with liraglutide (incremental cost-effectiveness ratio [ICER] = $40,100), and moderately cost-effective versus background treatment alone ([ICER] = $117,500/QALY) and sitagliptin (ICER = $145,200/QALY). The ICER for oral semaglutide compared with empagliflozin was approximately $458,400 per QALY. CONCLUSIONS: As modeled, oral semaglutide as an add-on therapy to background antihyperglycemic treatment produced incremental benefits in MACE avoided, along with greater QALYs compared with background antihyperglycemic treatment alone. Oral semaglutide use resulted in better outcomes than background treatment alone or sitagliptin, and similar outcomes to liraglutide or empagliflozin with overlapping 95% confidence ranges for QALYs. Oral semaglutide was estimated to be cost-effective compared with liraglutide and to have incremental cost-effectiveness ratios between $100,000 and $150,000 per QALY versus sitagliptin and background therapy alone, but it did not meet these thresholds compared with empagliflozin. DISCLOSURES: Funding for this study was provided by the Institute for Clinical and Economic Review, an independent organization that evaluates the evidence on the value of health care interventions. ICER reports grants from Laura and John Arnold Foundation, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan. ICER's annual policy summit is supported by dues from AbbVie, Aetna, America's Health Insurance Plans, Anthem, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Cambia Health Services, CVS, Editas, Evolve Pharmacy, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, Health Partners, Humana, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, uniQure, and United Healthcare. Rind, Fazioli, Chapman, and Pearson are employed by ICER. Guzauskas and Hansen have nothing to disclose. Study results were presented at the New England Comparative Effectiveness Public Advisory Council (New England CEPAC), November 14, 2019, at Brown University, Providence, RI.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/uso terapêutico, Adolescente, Adulto, Idoso, Idoso de 80 Anos ou mais, Análise Custo-Benefício, Quimioterapia Combinada, Feminino, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/economia, Humanos, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/economia, Masculino, Pessoa de Meia-Idade, Modelos Econômicos, Anos de Vida Ajustados por Qualidade de Vida, Estados Unidos, Adulto JovemRESUMO
AIMS: To assess the long-term cost-effectiveness of novel glucagon-like peptide-1 (GLP-1) analog oral semaglutide versus sodium-glucose cotransporter-2 inhibitor empagliflozin, dipeptidyl peptidase-4 inhibitor sitagliptin and injectable GLP-1 analog liraglutide in the Netherlands, based on the results of the PIONEER clinical trials. METHODS: Outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Clinical data were derived from PIONEER 2, 3 and 4. Patients were assumed to receive initial treatments until glycated hemoglobin exceeded 7.5%, then treatment-intensified to basal insulin therapy. Costs were accounted from a societal perspective in 2019 euros (EUR). RESULTS: Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.15, 0.22 and 0.09quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with combined costs EUR1,032 higher, EUR115 higher and EUR1,267 lower. Oral semaglutide was therefore associated with incremental cost-effectiveness ratios of EUR7,061 and EUR516 per QALY gained versus empagliflozin and sitagliptin, respectively. CONCLUSIONS: Based on long-term projections, oral semaglutide 14 mg was considered cost-effective versus empagliflozin 25 mg and sitagliptin 100 mg and dominant versus liraglutide 1.8 mg for the treatment of type 2 diabetes in the Netherlands.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Administração Oral, Análise Custo-Benefício, Feminino, Peptídeos Semelhantes ao Glucagon/farmacologia, Humanos, Hipoglicemiantes/farmacologia, Masculino, Pessoa de Meia-Idade, Países Baixos, Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Introduction: As a novel glucagon-like peptide-1receptor agonist (GLP-1 RA) for type 2 diabetes (T2D) treatment, the economic value of once-weekly semaglutide had been assessed in several country settings. The authors' objective was to systematically review the existing pharmacoeconomic literature evaluating the cost-effectiveness associated with once-weekly semaglutide compared with other GLP-1 RAs and provide implications for further researches.Areas covered: We conducted a systematic literature review of cost-effectiveness analysis (CEA) published up to 25 July 2020 in PubMed, web of science, and the ISPOR presentation database, compared once-weekly semaglutide with other GLP-1 RAs in T2D. Nineteen studies were identified, including 8 short-term and 11 long-term studies. General characteristics and main results of the included studies were summarized.Expert opinion: This review provided references for other countries to overview the value of once-weekly semaglutide compared with other GLP-1 RAs in T2D in the healthcare decision-making process and to conduct their CEA studies associated with once-weekly semaglutide. The authors found that the cardiovascular (CV) benefit of once-weekly semaglutide was under-estimated in current studies and suggested that the methods of economic evaluations for novel anti-diabetic drugs with CV benefit should be improved in future researches.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Hipoglicemiantes/administração & dosagem, Análise Custo-Benefício, Diabetes Mellitus Tipo 2/economia, Esquema de Medicação, Farmacoeconomia, Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/farmacologia, Humanos, Hipoglicemiantes/economia, Hipoglicemiantes/farmacologiaAssuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/uso terapêutico, Injúria Renal Aguda/induzido quimicamente, Administração Oral, Carcinoma Neuroendócrino/induzido quimicamente, Constipação Intestinal/induzido quimicamente, Retinopatia Diabética, Diarreia/induzido quimicamente, Dispepsia/induzido quimicamente, Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas, Peptídeos Semelhantes ao Glucagon/economia, Humanos, Hipoglicemia/induzido quimicamente, Hipoglicemiantes/economia, Náusea/induzido quimicamente, Pancreatite/induzido quimicamente, Neoplasias da Glândula Tireoide/induzido quimicamente, Vômito/induzido quimicamenteRESUMO
DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, Allergan, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Fazioli, Rind, and Pearson are employed by ICER. Gazauskas and Hansen have nothing to disclose.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Hipoglicemiantes/administração & dosagem, Administração Oral, Análise Custo-Benefício, Diabetes Mellitus Tipo 2/economia, Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas, Peptídeos Semelhantes ao Glucagon/economia, Humanos, Hipoglicemiantes/economia, Resultado do TratamentoRESUMO
INTRODUCTION: Once-weekly semaglutide 1 mg is a novel glucagon-like peptide-1 receptor agonist (GLP-1 RA) for the treatment of type 2 diabetes that has demonstrated significantly greater reductions in glycated haemoglobin (HbA1c) and body weight than the GLP-1 RA once-daily liraglutide 1.2 mg in the SUSTAIN 10 trial. The present analysis aimed to evaluate the long-term cost-effectiveness of once-weekly semaglutide 1 mg versus once-daily liraglutide 1.2 mg from a UK healthcare payer perspective. METHODS: Long-term outcomes were projected using the IQVIA CORE Diabetes Model (version 9.0), with baseline characteristics and treatment effects sourced from SUSTAIN 10. Patients were assumed to initiate treatment with GLP-1 RAs and continue treatment until HbA1c exceeded 7.5%, at which point GLP-1 RAs were discontinued and basal insulin was initiated. Pharmacy costs and costs of complications were measured in 2018 pounds sterling (GBP), with future costs and outcomes discounted at 3.5% per annum. Utilities were taken from published sources. RESULTS: In the base-case analysis, once-weekly semaglutide 1 mg was associated with an increase in discounted life expectancy of 0.21 years and discounted quality-adjusted life expectancy of 0.30 quality-adjusted life-years, compared with once-daily liraglutide 1.2 mg. Clinical benefits were achieved at reduced costs, with lifetime cost savings of GBP 140 per patient with semaglutide versus liraglutide, owing to a reduction in diabetes-related complications, in particular cardiovascular disease (mean cost saving of GBP 279 per patient). Therefore, once-weekly semaglutide 1 mg was dominant compared with once-daily liraglutide 1.2 mg. The results of the sensitivity analyses were similar, demonstrating the robustness of the base-case analysis. CONCLUSIONS: Once-weekly semaglutide 1 mg is a cost-effective treatment option versus once-daily liraglutide 1.2 mg, based on the SUSTAIN 10 trial, from a UK healthcare payer perspective.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/uso terapêutico, Liraglutida/uso terapêutico, Idoso, Peso Corporal, Análise Custo-Benefício, Complicações do Diabetes/economia, Complicações do Diabetes/prevenção & controle, Esquema de Medicação, Feminino, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/economia, Hemoglobinas Glicadas/análise, Humanos, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/economia, Liraglutida/administração & dosagem, Liraglutida/economia, Masculino, Pessoa de Meia-Idade, Modelos Econométricos, Anos de Vida Ajustados por Qualidade de Vida, Reino UnidoRESUMO
OBJECTIVES: Outcomes-based contracts tie rebates and discounts for expensive drugs to outcomes. The objective was to estimate the utility of outcomes-based contracts for diabetes medications using real-world data and to identify methodologic limitations of this approach. METHODS: A population-based cohort study of adults newly prescribed a medication for diabetes with a publicly announced outcomes-based contract (ie, exenatide microspheres ["exenatide"], dulaglutide, or sitagliptin) was conducted. The comparison group included patients receiving canagliflozin or glipizide. The primary outcome was announced in the outcomes-based contract: the percentage of adults with a follow-up hemoglobin A1C <8% up to 1 year later. Secondary outcomes included the percentage of patients diagnosed with hypoglycemia and the cost of a 1-month supply. RESULTS: Thousands of adults newly filled prescriptions for exenatide (n = 5079), dulaglutide (n = 6966), sitagliptin (n = 40 752), canagliflozin (n = 16 404), or glipizide (n = 59 985). The percentage of adults subsequently achieving a hemoglobin A1C below 8% ranged from 83% (dulaglutide, sitagliptin) to 71% (canagliflozin). The rate of hypoglycemia was 25 per 1000 person-years for exenatide, 37 per 1000 person-years for dulaglutide, 28 per 1000 person-years for sitagliptin, 18 per 1000 person-years for canagliflozin, and 34 per 1000 person-years for glipizide. The cash price for a 1-month supply was $847 for exenatide, $859 for dulaglutide, $550 for sitagliptin, $608 for canagliflozin, and $14 for glipizide. CONCLUSION: Outcomes-based pricing of diabetes medications has the potential to lower the cost of medications, but using outcomes such as hemoglobin A1C may not be clinically meaningful because similar changes in A1C can be achieved with generic medications at a far lower cost.
Assuntos
Contratos/economia, Diabetes Mellitus Tipo 2/tratamento farmacológico, Hipoglicemiantes/administração & dosagem, Avaliação de Resultados em Cuidados de Saúde/métodos, Idoso, Canagliflozina/administração & dosagem, Canagliflozina/economia, Estudos de Coortes, Diabetes Mellitus Tipo 2/economia, Exenatida/administração & dosagem, Exenatida/economia, Feminino, Seguimentos, Glipizida/administração & dosagem, Glipizida/economia, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/análogos & derivados, Peptídeos Semelhantes ao Glucagon/economia, Humanos, Hipoglicemiantes/economia, Fragmentos Fc das Imunoglobulinas/administração & dosagem, Fragmentos Fc das Imunoglobulinas/economia, Masculino, Pessoa de Meia-Idade, Proteínas Recombinantes de Fusão/administração & dosagem, Proteínas Recombinantes de Fusão/economia, Fosfato de Sitagliptina/administração & dosagem, Fosfato de Sitagliptina/economiaRESUMO
INTRODUCTION: Once-weekly semaglutide 1 mg is a novel glucagon-like peptide 1 receptor agonist (GLP-1 RA) that, in the SUSTAIN clinical trials, has demonstrated greater reductions in glycated haemoglobin (HbA1c) and body weight than the other GLP-1 RAs exenatide extended-release (ER) 2 mg, dulaglutide 1.5 mg and liraglutide 1.2 mg. The aim of this analysis was to evaluate the relative cost of control of achieving treatment goals in people with type 2 diabetes (T2D) treated with once-weekly semaglutide versus exenatide ER, dulaglutide and liraglutide from a UK perspective. METHODS: Proportions of patients reaching HbA1c targets (< 7.0% and < 7.5%), weight loss targets (≥ 5% reduction in body weight) and composite endpoints (HbA1c < 7.0% without weight gain or hypoglycaemia; reduction in HbA1c of ≥ 1% and weight loss of ≥ 5%) were obtained from the SUSTAIN clinical trials. Annual per patient treatment costs were based on wholesale acquisition costs from July 2019 in the UK. Cost of control was calculated by plotting relative treatment costs against relative efficacy. RESULTS: The annual per patient cost was similar for all GLP-1 RAs. Once-weekly semaglutide was superior to exenatide ER, dulaglutide and liraglutide in bringing patients to HbA1c and weight loss targets, and to composite endpoints. When looking at the composite endpoint of HbA1c < 7.0% without weight gain or hypoglycaemia, exenatide ER, dulaglutide and liraglutide were 50.0%, 21.6% and 51.3% less efficacious in achieving this, respectively, than once-weekly semaglutide. Consequently, the efficacy-to-cost ratios for once-weekly semaglutide were superior to all comparators in bringing patients to all endpoints. CONCLUSIONS: The present study showed that once-weekly semaglutide offers superior cost of control versus exenatide ER, dulaglutide and liraglutide in terms of achieving clinically relevant, single and composite endpoints. Once-weekly semaglutide 1 mg would therefore represent good value for money in the UK setting.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Peso Corporal, Análise Custo-Benefício, Esquema de Medicação, Exenatida/economia, Exenatida/uso terapêutico, Feminino, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/análogos & derivados, Hemoglobinas Glicadas/análise, Humanos, Hipoglicemia/induzido quimicamente, Hipoglicemiantes/administração & dosagem, Fragmentos Fc das Imunoglobulinas/economia, Fragmentos Fc das Imunoglobulinas/uso terapêutico, Liraglutida/economia, Liraglutida/uso terapêutico, Masculino, Pessoa de Meia-Idade, Proteínas Recombinantes de Fusão/economia, Proteínas Recombinantes de Fusão/uso terapêutico, Reino Unido, Aumento de PesoRESUMO
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 cost- effectiveness of oral semaglutide 14 mg versus subcutaneous once-weekly dulaglutide 1.5 mg, once-weekly exenatide 2 mg, twice-daily exenatide 10 µg, once-daily liraglutide 1.8 mg, once-daily lixisenatide 20 µg, 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.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Administração Oral, Análise Custo-Benefício, Esquema de Medicação, Exenatida/uso terapêutico, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/efeitos adversos, Peptídeos Semelhantes ao Glucagon/análogos & derivados, Hemoglobinas Glicadas, Humanos, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/efeitos adversos, Fragmentos Fc das Imunoglobulinas/uso terapêutico, Injeções Subcutâneas, Liraglutida/uso terapêutico, Peptídeos/uso terapêutico, Proteínas Recombinantes de Fusão/uso terapêuticoRESUMO
Aims: Controlling costs while maximizing healthcare gains is the predominant challenge for healthcare providers, and therefore cost-effectiveness analysis is playing an ever-increasing role in healthcare decision making. The aim of the present analysis was to assess the long-term cost-effectiveness of subcutaneous once-weekly semaglutide (0.5 mg and 1 mg) versus empagliflozin (10 mg and 25 mg) in the Spanish setting for the treatment of patients with type 2 diabetes (T2D) with inadequate glycemic control on oral anti-hyperglycemic medications.Material and methods: The IQVIA CORE Diabetes Model was used to project outcomes over patient lifetimes with once-weekly semaglutide versus empagliflozin, with treatment effects based on a network meta-analysis. The analysis captured treatment costs, costs of diabetes-related complications, and the impact of complications on quality of life, based on published sources. Outcomes were discounted at 3.0% per annum.Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted quality-adjusted life expectancy of 0.12 and 0.15 quality-adjusted life years (QALYs), respectively, versus empagliflozin 10 mg and improvements of 0.11 and 0.14 QALYs, respectively, versus empagliflozin 25 mg. Treatment costs were higher with once-weekly semaglutide compared with empagliflozin, but this was partially offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 0.5 mg and 1 mg were associated with incremental cost-effectiveness ratios of EUR 2,285 and EUR 161 per QALY gained, respectively, versus empagliflozin 10 mg, and EUR 3,090 and EUR 625 per QALY gained, respectively, versus empagliflozin 25 mg.Conclusions: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg were projected to be cost-effective versus empagliflozin 10 mg and 25 mg for the treatment of patients with T2D with inadequate glycemic control on oral anti-hyperglycemic medications in the Spanish setting, irrespective of patients' BMI at baseline.
Assuntos
Compostos Benzidrílicos/uso terapêutico, Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Glucosídeos/uso terapêutico, Hipoglicemiantes/uso terapêutico, Compostos Benzidrílicos/administração & dosagem, Compostos Benzidrílicos/economia, Pressão Sanguínea, Peso Corporal, Análise Custo-Benefício, Complicações do Diabetes/economia, Complicações do Diabetes/prevenção & controle, Vias de Administração de Medicamentos, Esquema de Medicação, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Peptídeos Semelhantes ao Glucagon/análogos & derivados, Peptídeos Semelhantes ao Glucagon/economia, Glucosídeos/administração & dosagem, Glucosídeos/economia, Hemoglobinas Glicadas, Humanos, Hipoglicemiantes/administração & dosagem, Hipoglicemiantes/economia, Modelos Econométricos, Modelos Estatísticos, Metanálise em Rede, Anos de Vida Ajustados por Qualidade de Vida, Inibidores do Transportador 2 de Sódio-Glicose/economia, Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico, EspanhaRESUMO
Aims: To report 1-year clinical and economic outcomes from the retrospective DISPEL (Dulaglutide vs Basal InSulin in Injection Naïve Patients with Type 2 Diabetes: Effectiveness in ReaL World) Study. Materials and methods: This observational claims study included patients with type 2 diabetes (T2D) and ≥1 claim for dulaglutide or basal insulin between November 2014 and April 2017 (index date=earliest fill date). Propensity score matching was used to address treatment selection bias. Change from baseline in hemoglobin A1c (HbA1c) was compared between the matched cohorts using analysis of covariance; diabetes-related costs were analyzed using generalized linear models. Results: Matched cohorts (903 pairs total; 523 pairs with complete cost data) were balanced in baseline characteristics with mean HbA1c 8.6%, mean age 54 years. At 1 year postindex, dulaglutide patients had significantly greater reduction in HbA1c than basal insulin (-1.12% vs -0.51%, p<0.01), lower medical costs ($3753 vs $7604, p<0.01), higher pharmacy costs ($9809 vs $6175, p<0.01), and similar total costs ($13 562 vs $13 779, p=0.76). Medical and total costs per 1% HbA1c reduction were lower for dulaglutide than basal insulin (medical: $3128 vs $12 673, p<0.01; total: $11 302 vs $22 965, p<0.01), while pharmacy costs per 1% HbA1c reduction were lower without reaching statistical significance ($8174 vs $10 292, p=0.15). Conclusions: In this real-world study, patients with T2D initiating dulaglutide demonstrated greater HbA1c reduction compared with those initiating basal insulin. Although total diabetes-related costs were similar, the total diabetes-related costs per HbA1c reduction were lower for dulaglutide, highlighting the importance of evaluating effectiveness along with the economic impact of medications.
Assuntos
Biomarcadores/análise, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/economia, Peptídeos Semelhantes ao Glucagon/análogos & derivados, Custos de Cuidados de Saúde/estatística & dados numéricos, Hipoglicemiantes/uso terapêutico, Fragmentos Fc das Imunoglobulinas/uso terapêutico, Insulina/uso terapêutico, Proteínas Recombinantes de Fusão/uso terapêutico, Glicemia/análise, Diabetes Mellitus Tipo 2/patologia, Feminino, Seguimentos, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hemoglobinas Glicadas/análise, Humanos, Hipoglicemiantes/economia, Fragmentos Fc das Imunoglobulinas/economia, Insulina/economia, Estudos Longitudinais, Masculino, Pessoa de Meia-Idade, Prognóstico, Proteínas Recombinantes de Fusão/economia, Estudos Retrospectivos, Estados UnidosRESUMO
Objective: Choosing therapies for type 2 diabetes that are both effective and cost-effective is vital as healthcare systems worldwide aim to maximize health of the population. The present analysis assessed the cost-effectiveness of once-weekly semaglutide (a novel glucagon-like peptide-1 (GLP-1) receptor agonist) versus insulin glargine U100 (the most commonly used basal insulin) and versus dulaglutide (an alternative once-weekly GLP-1 receptor agonist), from a societal perspective in the Netherlands. Research design and methods: The IQVIA CORE Diabetes Model was used to project outcomes for once-weekly semaglutide 0.5 mg and 1 mg versus insulin glargine U100, once-weekly semaglutide 0.5 mg versus dulaglutide 0.75 mg, and once-weekly semaglutide 1 mg versus dulaglutide 1.5 mg. Clinical data were taken from the SUSTAIN 4 and SUSTAIN 7 clinical trials. The analysis captured direct and indirect costs, mortality, and the impact of diabetes-related complications on quality of life. Results: Projections of outcomes suggested that once-weekly semaglutide 0.5 mg was associated with improved quality-adjusted life expectancy by 0.19 quality-adjusted life years (QALYs) versus insulin glargine U100 and 0.07 QALYs versus dulaglutide 0.75 mg. Once-weekly semaglutide 1 mg was associated with mean increases in quality-adjusted life expectancy of 0.27 QALYs versus insulin glargine U100 and 0.13 QALYs versus dulaglutide 1.5 mg. Improvements came at an increased cost versus insulin glargine U100, with incremental cost-effectiveness ratios from a societal perspective of 4988 and 495 per QALY gained for once-weekly semaglutide 0.5 mg and 1 mg, respectively, falling below Netherlands-specific willingness-to-pay thresholds. Improvements versus dulaglutide came at a reduced cost from a societal perspective for both doses of once-weekly semaglutide. Conclusions: Once-weekly semaglutide is cost-effective versus insulin glargine U100, and dominant versus dulaglutide 0.75 and 1.5 mg for the treatment of type 2 diabetes, and represents a good use of healthcare resources in the Netherlands.
Assuntos
Análise Custo-Benefício, Diabetes Mellitus Tipo 2/economia, Peptídeos Semelhantes ao Glucagon/economia, Hipoglicemiantes/economia, Insulina Glargina/economia, Qualidade de Vida, Biomarcadores/análise, Glicemia/análise, Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/epidemiologia, Feminino, Seguimentos, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Humanos, Hipoglicemiantes/uso terapêutico, Insulina Glargina/uso terapêutico, Expectativa de Vida, Masculino, Pessoa de Meia-Idade, Países Baixos/epidemiologia, PrognósticoRESUMO
INTRODUCTION: Oral semaglutide is the first orally administered glucagon-like peptide-1 receptor agonist for the treatment of type 2 diabetes, and has been evaluated in the PIONEER clinical trial program. These trials assessed the proportions of patients achieving single and composite endpoints, encompassing glycemic control [defined in terms of glycated hemoglobin (HbA1c)], weight loss, and hypoglycemia. The present study assessed the cost of control with oral semaglutide versus empagliflozin, sitagliptin, and liraglutide in the US. METHODS: Four endpoints were evaluated: (1) HbA1c ≤ 6.5%; (2) HbA1c < 7.0%; (3) ≥ 1.0%-point HbA1c reduction and weight loss ≥ 3.0%; and (4) HbA1c < 7.0% without hypoglycemia and without weight gain. The proportions of patients achieving each endpoint were sourced from the PIONEER 2, 3 and 4 trials. Treatment costs were accounted over an annual time-period in 2019 US dollars (USD), based on wholesale acquisition cost. Cost of control was calculated by dividing treatment costs by the proportion of patients achieving each target. RESULTS: Oral semaglutide was consistently associated with the lowest cost of control for all four endpoints. For the targets of HbA1c ≤ 6.5% and HbA1c < 7.0%, oral semaglutide 14 mg was associated with lower cost of control than empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg by USD 15,036, 14,697, and 6996, respectively, and USD 931, 346 and 4497, respectively. For the double composite endpoint, cost of control was lower with oral semaglutide 14 mg by USD 525, 32,277 and 13,011, respectively versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg. For the triple composite endpoint, cost of control was lower with oral semaglutide 14 mg by USD 1255, 7510 and 5774, respectively. CONCLUSION: Oral semaglutide was associated with lower cost of bringing patients with type 2 diabetes to four clinically-relevant treatment targets versus empagliflozin, sitagliptin, and liraglutide in the US. FUNDING: Novo Nordisk A/S.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Compostos Benzidrílicos/economia, Compostos Benzidrílicos/uso terapêutico, Glicemia/efeitos dos fármacos, Análise Custo-Benefício, Glucosídeos/economia, Glucosídeos/uso terapêutico, Hemoglobinas Glicadas/análise, Humanos, Hipoglicemia/induzido quimicamente, Liraglutida/economia, Liraglutida/uso terapêutico, Pessoa de Meia-Idade, Fosfato de Sitagliptina/economia, Fosfato de Sitagliptina/uso terapêutico, Estados Unidos, Redução de PesoRESUMO
INTRODUCTION: Glucagon-like peptide-1 (GLP-1) receptor agonists represent a class of treatments for type 2 diabetes that offer multifactorial benefits, including glycemic control, weight loss and low hypoglycemia risk. Once-weekly semaglutide is a novel GLP-1 analog that has been associated with improved glycemic control and reduced body mass index (BMI) versus once-weekly GLP-1 receptor agonist dulaglutide in SUSTAIN 7, which is reimbursed in patients with a BMI > 35 kg/m2 in Slovakia. The aim of the present study was to evaluate the long-term cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus dulaglutide 1.5 mg in Slovakia. METHODS: Clinical and cost outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline cohort characteristics and treatment effects were based on the sub-group of patients with a BMI > 35 kg/m2 in SUSTAIN 7. Patients were modeled to receive once-weekly semaglutide or dulaglutide for 3 years, after which treatment was intensified to basal insulin. Treatment effects associated with once-weekly semaglutide and dulaglutide were maintained for the first 3 years before HbA1c increased to 7.0% and BMI reverted to baseline. Costs were accounted from a healthcare payer perspective in Slovakia and expressed in euros (EUR). Utilities relating to quality of life were taken from published sources. RESULTS: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.04 and 0.07 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg. Lifetime medical costs were similar, with cost savings of EUR 20 and EUR 140 per patient with once-weekly semaglutide 0.5 mg and 1 mg, respectively, versus dulaglutide 1.5 mg. Both doses of once-weekly semaglutide were therefore considered dominant versus dulaglutide 1.5 mg. CONCLUSION: Both doses of once-weekly semaglutide represent cost-saving treatment options versus dulaglutide 1.5 mg for obese patients with type 2 diabetes in Slovakia. FUNDING: Novo Nordisk A/S.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico, Diabetes Mellitus Tipo 2/economia, Esquema de Medicação, Peptídeos Semelhantes ao Glucagon/economia, Peptídeos Semelhantes ao Glucagon/uso terapêutico, Hipoglicemiantes/economia, Hipoglicemiantes/uso terapêutico, Adulto, Idoso, Idoso de 80 Anos ou mais, Análise Custo-Benefício, Diabetes Mellitus Tipo 2/epidemiologia, Feminino, Peptídeos Semelhantes ao Glucagon/administração & dosagem, Humanos, Hipoglicemiantes/administração & dosagem, Masculino, Pessoa de Meia-Idade, Eslováquia/epidemiologiaRESUMO
Aims: This analysis evaluated the cost-effectiveness of once-weekly semaglutide vs glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2D) uncontrolled on metformin or basal insulin in Sweden. Materials and methods: This cost-effectiveness analysis (CEA) was conducted using the Swedish Institute of Health Economics (IHE) Diabetes Cohort Model. Analyses were conducted from the Swedish societal perspective over a time horizon of 40 years. For patients uncontrolled on metformin, dulaglutide was the comparator, and data from the SUSTAIN 7 clinical trial was used. For patients uncontrolled on basal insulin, lixisenatide was chosen as the comparator and data was obtained from a network meta-analysis (NMA). Results: The results show that, in patients with inadequate control on metformin, semaglutide 1.0 mg dominated (i.e. provided greater clinical benefit, and was less costly) dulaglutide 1.5 mg. In patients with inadequate control on basal insulin, semaglutide 1.0 mg dominated lixisenatide. The reduction in costs is largely driven by the reduction in complications seen with once-weekly semaglutide. Limitations and conclusions: It is likely that this analysis is conservative in estimating the cardiovascular (CV) cost benefits associated with treatment with once-weekly semaglutide. In patients inadequately controlled on basal insulin, the analyses vs lixisenatide were based on results from an NMA, as no head-to-head clinical trial has been conducted for this comparison. These CEA results show that once-weekly semaglutide is a cost-effective GLP-1 RA therapy for the treatment of T2D in patients inadequately controlled on metformin or basal insulin, addressing many current clinician, patient, and payer unmet needs in Sweden.
