Estimating the Cost at which GLP-1 RAs Would become Cost-Effective for Multimorbid Type 2 Diabetes Patients in Canada
Moderator
Ethan McNally, Toronto, ON, Canada
Speakers
Pedro Marques; Elite Possik; Ankur Pandya, MPH, PhD, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Michael Tsoukas; Thomas Mavrakanas; Kaberi Dasgupta; Nisha Gupta; Abhinav Sharma; Alton Russell
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)