A U.S.-SPECIFIC BUDGET IMPACT MODEL (BIM) OF SEMAGLUTIDE 2.4 MG IN THE TREATMENT OF METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS (MASH) USING MOST FAVORED NATION (MFN) PRICING
Author(s)
Aidan McGovern, MPH, MS1, Frank Cinfio, BS2, Aarth Sheth, PharmD1, Minseon Chung, PharmD, MPH, MS1, Roger Luo, PhD, MS1, Oliver Diaz, PhD, MS1, ARuth OMartinez, MS1, Husam Albarmawi, PhD1;
1Novo Nordisk Inc., Plainsboro, NJ, USA, 2Genesis Research Group, Hoboken, NJ, USA
1Novo Nordisk Inc., Plainsboro, NJ, USA, 2Genesis Research Group, Hoboken, NJ, USA
OBJECTIVES: Metabolic dysfunction-associated steatohepatitis (MASH) is a form of liver inflammation and injury caused by nonalcohol-related fat buildup that often progresses to serious complications such as cirrhosis, liver failure, and cancer. Many of the risk factors for MASH include obesity, type 2 diabetes (T2D), high LDL levels, and metabolic syndrome. Semaglutide was recently approved for the treatment of MASH, with moderate to advanced liver fibrosis (consistent with stages F2 to F3 fibrosis) in adults. A budget impact model (BIM) was developed to estimate the financial consequences of adopting semaglutide for MASH treatment using the most favored nation (MFN) price.
METHODS: The BIM adopted a U.S. healthcare commercial payer and Medicare perspective, focusing on direct medical costs. The model used a 5-year time horizon, reflecting typical budget planning periods, with results reported annually. The model accounted for disease state transition using a Markov cohort structure. The treatment-eligible population for semaglutide was estimated based on previously published literature. Model inputs included estimated treatment mixes for resmetirom and standard of care (SoC) and the MFN price for semaglutide.
RESULTS: From a commercial perspective over five years, semaglutide generated cumulative cost savings of $89,887,117, including $77,040,929 from treatment costs. Monitoring costs for MASH increased by $257,129, while reductions in disease management costs contributed $13,103,316 in savings. This translated to $1.48 PMPM and $863 PTMPM in savings. From a Medicare perspective over five years, semaglutide generated cumulative cost savings of $98,748,109, which translated to savings of $1.63 PMPM and $863 PTMPM.
CONCLUSIONS: The introduction of semaglutide for MASH at the MFN price was associated with substantial five-year net savings from a U.S. payer perspective. These savings were driven largely by reduced treatment and disease management costs that outweighed modest increases in monitoring expenditures. This analysis suggests semaglutide may be an appropriate option for consideration in formulary decision-making.
METHODS: The BIM adopted a U.S. healthcare commercial payer and Medicare perspective, focusing on direct medical costs. The model used a 5-year time horizon, reflecting typical budget planning periods, with results reported annually. The model accounted for disease state transition using a Markov cohort structure. The treatment-eligible population for semaglutide was estimated based on previously published literature. Model inputs included estimated treatment mixes for resmetirom and standard of care (SoC) and the MFN price for semaglutide.
RESULTS: From a commercial perspective over five years, semaglutide generated cumulative cost savings of $89,887,117, including $77,040,929 from treatment costs. Monitoring costs for MASH increased by $257,129, while reductions in disease management costs contributed $13,103,316 in savings. This translated to $1.48 PMPM and $863 PTMPM in savings. From a Medicare perspective over five years, semaglutide generated cumulative cost savings of $98,748,109, which translated to savings of $1.63 PMPM and $863 PTMPM.
CONCLUSIONS: The introduction of semaglutide for MASH at the MFN price was associated with substantial five-year net savings from a U.S. payer perspective. These savings were driven largely by reduced treatment and disease management costs that outweighed modest increases in monitoring expenditures. This analysis suggests semaglutide may be an appropriate option for consideration in formulary decision-making.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE109
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Gastrointestinal Disorders, SDC: Geriatrics