COST-EFFECTIVENESS OF SEMAGLUTIDE FOR METABOLIC DYSFUNCTION-ASSOCIATED STEATOHEPATITIS UNDER MEDICARE DRUG PRICE NEGOTIATIONS
Author(s)
Siang-Hao Cheng, MS1, Poorva Birari, MS2, Anton Avanceña, PhD3;
1The University of Texas at Austin College of Pharmacy, Health Outcomes Division, Austin, TX, USA, 2The University of Texas at Austin College of Pharmacy, Austin, TX, USA, 3The University of Texas at Austin, Austin, TX, USA
1The University of Texas at Austin College of Pharmacy, Health Outcomes Division, Austin, TX, USA, 2The University of Texas at Austin College of Pharmacy, Austin, TX, USA, 3The University of Texas at Austin, Austin, TX, USA
OBJECTIVES: Semaglutide (Wegovy®) injection was approved for the treatment of metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate-to-advanced liver fibrosis in August 2025. We evaluated the cost-effectiveness of semaglutide compared with resmetirom (Rezdiffra®, approved in 2024) and standard of care (SoC) from a U.S. healthcare system perspective.
METHODS: We adopted a lifetime microsimulation model to compare once-weekly 2.4mg semaglutide with once-daily 100mg oral resmetirom and SoC over 52 weeks. The model (developed by Younossi et al., 2025) simulates U.S. adults with MASH transitioning through health states including fibrosis stages (F0-F3), compensated and decompensated cirrhosis, hepatocellular carcinoma, post-transplant states, and death. Treatment efficacy was derived from two phase 3 trials. We parameterized the model using data on annual costs, transition probabilities, and health utilities from previously published literature. Health benefits were measured in quality-adjusted life years (QALYs) gained. We applied a 3% annual discount rate. All costs are reported in 2025 U.S. dollars. Scenario analyses explored alternative drug costs: (1) 2025 pre-negotiation semaglutide price ($12,102/year) vs. negotiated price ($4,628/year), and (2) resmetirom at a lower price assumed in prior evaluations ($19,011/year) vs. current U.S. price ($35,396/year).
RESULTS: Preliminary results show that semaglutide is cost-effective versus SoC (incremental cost: $14,206; incremental QALYs: 0.212; incremental cost-effectiveness ratio [ICER]: $66,987/QALY). Resmetirom generated higher QALYs (12.551 vs. 12.069) than semaglutide at higher total costs ($221,390 vs. $67,457), yielding an ICER of $319,504/QALY. Using 2025 pre-negotiation pricing, semaglutide’s ICER versus SoC increased to $250,862/QALY. Using a lower resmetirom cost ($19,011/year), resmetirom's ICER improved to $148,626/QALY versus semaglutide, approaching conventional cost-effectiveness thresholds.
CONCLUSIONS: Semaglutide is a cost-effective treatment for MASH, assuming its costs are equal to the 2027 Medicare negotiated price. Resmetirom also meets thresholds for cost-effectiveness with a lower price. Both therapies demonstrate potential economic value, with cost-effectiveness largely determined by drug pricing.
METHODS: We adopted a lifetime microsimulation model to compare once-weekly 2.4mg semaglutide with once-daily 100mg oral resmetirom and SoC over 52 weeks. The model (developed by Younossi et al., 2025) simulates U.S. adults with MASH transitioning through health states including fibrosis stages (F0-F3), compensated and decompensated cirrhosis, hepatocellular carcinoma, post-transplant states, and death. Treatment efficacy was derived from two phase 3 trials. We parameterized the model using data on annual costs, transition probabilities, and health utilities from previously published literature. Health benefits were measured in quality-adjusted life years (QALYs) gained. We applied a 3% annual discount rate. All costs are reported in 2025 U.S. dollars. Scenario analyses explored alternative drug costs: (1) 2025 pre-negotiation semaglutide price ($12,102/year) vs. negotiated price ($4,628/year), and (2) resmetirom at a lower price assumed in prior evaluations ($19,011/year) vs. current U.S. price ($35,396/year).
RESULTS: Preliminary results show that semaglutide is cost-effective versus SoC (incremental cost: $14,206; incremental QALYs: 0.212; incremental cost-effectiveness ratio [ICER]: $66,987/QALY). Resmetirom generated higher QALYs (12.551 vs. 12.069) than semaglutide at higher total costs ($221,390 vs. $67,457), yielding an ICER of $319,504/QALY. Using 2025 pre-negotiation pricing, semaglutide’s ICER versus SoC increased to $250,862/QALY. Using a lower resmetirom cost ($19,011/year), resmetirom's ICER improved to $148,626/QALY versus semaglutide, approaching conventional cost-effectiveness thresholds.
CONCLUSIONS: Semaglutide is a cost-effective treatment for MASH, assuming its costs are equal to the 2027 Medicare negotiated price. Resmetirom also meets thresholds for cost-effectiveness with a lower price. Both therapies demonstrate potential economic value, with cost-effectiveness largely determined by drug pricing.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE343
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), STA: Multiple/Other Specialized Treatments