Presentation (CTI)

OBJECTIVES: To evaluate the cost-utility of oral semaglutide (14 mg once daily) compared to dipeptidyl peptidase-4 inhibitors (DPP4i), sodium-glucose cotransporter-2 inhibitors (iSGLT2), and their combination (SGLT2i + DPP4i) for treating Type 2 Diabetes (T2D) patients inadequately controlled with metformin monotherapy in the Colombian health system.
METHODS: Three independent and complementary Markov models were developed to estimate QALYs and controlled cases (glycated hemoglobin (HbA1c) < 7%), considering efficacy, safety, adherence, inertia, and complications: microvascular (different stages of retinopathy and nephropathy) and macrovascular (ischemic heart disease, acute myocardial infarction, stroke, and congestive heart failure). Effectiveness differences between treatments were determined based on reductions in glycated hemoglobin (HbA1c) levels observed in clinical trials and real-world data. Resource costs were estimated from a Colombian health system perspective (for 2023) based on the national drug pricing information system and expressed in US dollars. Time horizons of one, two, and five years (base case) were implemented. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: Oral semaglutide (14 mg once daily) demonstrated superior outcomes across all evaluated metrics (QALYs and controlled cases) in the three scenarios analyzed. Over a 5-year time horizon, the per-patient differences in favor of oral semaglutide were as follows: cost savings of $878, $648, and $707; QALY gains of 0.07, 0.05, and 0.03; and additional controlled cases of 0.29, 0.21, and 0.11, compared to DPP4i, iSGLT2, and the combination SGLT2i + DPP4i, respectively.
CONCLUSIONS: This analysis suggests that oral semaglutide (14 mg once daily) represents a cost-effective option for treating Type 2 Diabetes patients within the Colombian health system, providing superior health and economic outcomes compared to DPP4i, iSGLT2, and combination therapies.