Estimating the Cost at which GLP-1 RAs Would become Cost-Effective for Multimorbid Type 2 Diabetes Patients in Canada
Author(s)
Ethan McNally, BA1, Pedro Marques, MD2, Elite Possik, PhD3, Ankur Pandya, PhD4, Michael Tsoukas, MD5, Thomas Mavrakanas, MD6, Kaberi Dasgupta, MD7, Nisha Gupta, MD,CM,MBA7, Abhinav Sharma, MD, PhD8, Alton Russell, PhD9.
1Department of Economics, McGill University, Montreal, QC, Canada, 2Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center, Porto, Portugal, 3DREAM-CV Lab, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 4Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA, 5Department of Endocrinology, McGill University Health Centre, Montreal, QC, Canada, 6Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 7Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada, 8Division of Clinical and Translational Research, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 9School of Population and Global Health, McGill University, Montreal, QC, Canada.
1Department of Economics, McGill University, Montreal, QC, Canada, 2Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center, Porto, Portugal, 3DREAM-CV Lab, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 4Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA, 5Department of Endocrinology, McGill University Health Centre, Montreal, QC, Canada, 6Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 7Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada, 8Division of Clinical and Translational Research, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada, 9School of Population and Global Health, McGill University, Montreal, QC, Canada.
Presentation Documents
OBJECTIVES: Spending on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes (T2D) has rapidly increased in Canada. We conducted a model-based cost-effectiveness analysis from a healthcare payer perspective to estimate the cost at which GLP-1 RAs would become cost-effective for patients with T2D and cardiovascular or renal comorbidities.
METHODS: We developed a simulation model using the UKPDS-OM-2 risk equations, re-calibrated to recent trials for GLP-1 RAs and sodium-glucose cotransporter 2 inhibitors (SGLT2is), another recent T2D therapy. Using cost and quality of life inputs from the literature, we estimated the cost-effectiveness of “business-as-usual” therapy (calibrated to the placebo arm of clinical trials), SGLT2is, and GLP-1 RAs. We used a patient lifetime horizon and 2023 Canadian dollars. Annual GLP-1 RA cost (dulaglutide, semaglutide) was $2,370 based on Quebec provincial drug list pricing. We estimated the probability of cost-effectiveness at a willingness-to-pay threshold, as the proportion of probability sensitivity analysis iterations where the net monetary benefit of GLP-1 RAs exceeded the net monetary benefit of the comparator.
RESULTS: GLP-1 RAs produced more net-present quality-adjusted life years (QALYs) than business-as-usual (10.74 vs. 10.50 per patient), but fewer than SGLT2is (10.78). At a willingness-to-pay threshold of $50,000 per QALY, the cost of GLP-1 RAs would need to fall below $1339 and $1147 to have a 50% and 80% probability of being cost-effective compared to business-as-usual, respectively. For GLP-1 RAs to have >50% probability of being preferred over SGLT2i, the annual cost would need to fall below $636, less than the SGLT2i annual cost ($722).
CONCLUSIONS: Despite proven effectiveness, GLP-1 RAs would require large cost decreases to become cost-effective in Canada at a $50,000 -per -QALY threshold, especially relative to SGLT2is, which are currently less expensive and are estimated to produce slightly more quality-adjusted life years per patient.
METHODS: We developed a simulation model using the UKPDS-OM-2 risk equations, re-calibrated to recent trials for GLP-1 RAs and sodium-glucose cotransporter 2 inhibitors (SGLT2is), another recent T2D therapy. Using cost and quality of life inputs from the literature, we estimated the cost-effectiveness of “business-as-usual” therapy (calibrated to the placebo arm of clinical trials), SGLT2is, and GLP-1 RAs. We used a patient lifetime horizon and 2023 Canadian dollars. Annual GLP-1 RA cost (dulaglutide, semaglutide) was $2,370 based on Quebec provincial drug list pricing. We estimated the probability of cost-effectiveness at a willingness-to-pay threshold, as the proportion of probability sensitivity analysis iterations where the net monetary benefit of GLP-1 RAs exceeded the net monetary benefit of the comparator.
RESULTS: GLP-1 RAs produced more net-present quality-adjusted life years (QALYs) than business-as-usual (10.74 vs. 10.50 per patient), but fewer than SGLT2is (10.78). At a willingness-to-pay threshold of $50,000 per QALY, the cost of GLP-1 RAs would need to fall below $1339 and $1147 to have a 50% and 80% probability of being cost-effective compared to business-as-usual, respectively. For GLP-1 RAs to have >50% probability of being preferred over SGLT2i, the annual cost would need to fall below $636, less than the SGLT2i annual cost ($722).
CONCLUSIONS: Despite proven effectiveness, GLP-1 RAs would require large cost decreases to become cost-effective in Canada at a $50,000 -per -QALY threshold, especially relative to SGLT2is, which are currently less expensive and are estimated to produce slightly more quality-adjusted life years per patient.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PT20
Topic
Economic Evaluation
Topic Subcategory
Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)