Cost-Utility Analysis of Adding Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors or Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists to Standard Therapy in Thai Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease
Author(s)
Pattara Leelahavarong, Ph.D.1, Natthakan Chitpim, Pharm.D.1, varalak srinonprasert, MD2, Tanawan Kongmalai, PhD3.
1Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2Division of Geriatric Medicine, Department of Medicine and Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Division of Endocrinology and Metabolism, Department of Medicine and Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol university, Bangkok, Thailand.
1Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 2Division of Geriatric Medicine, Department of Medicine and Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Division of Endocrinology and Metabolism, Department of Medicine and Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol university, Bangkok, Thailand.
OBJECTIVES: Type 2 diabetes mellitus (T2DM) with established atherosclerotic cardiovascular disease (ASCVD) significantly increases healthcare costs in Thailand. Despite proven cardiovascular benefits globally, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 (GLP-1) receptor agonists are not listed in Thailand’s National List of Essential Medicines (NLEM). This study evaluates their cost-effectiveness as additions to standard care (SoC) to inform reimbursement decisions.
METHODS: A semi-Markov model was employed to estimate lifetime health outcomes and societal costs of adding SGLT2i (i.e. dapagliflozin, empagliflozin, and canagliflozin) or GLP-1 receptor agonists (semaglutide) to SoC versus SoC alone. Model inputs were derived from subgroup analyses of randomized control trials, national administrative databases, hospital records, and patient-reported data. Outcomes were measured in quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs), assessed against Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (USD 4,916) per QALY. Costs and outcomes were discounted at 3% annually, and parameter uncertainty was explored through deterministic and probabilistic sensitivity analyses.
RESULTS: Compared to SoC, canagliflozin generated the greatest QALYs gain (0.45), followed by dapagliflozin (0.26), pooled SGLT2i (0.22), semaglutide (0.13), and empagliflozin (0.10). ICERs per QALY gained were USD 10,442 (canagliflozin), USD 15,154 (dapagliflozin), USD 17,470 (pooled SGLT2i), USD 34,834 (empagliflozin), and USD 130,262 (semaglutide), all exceeding the national WTP threshold. Sensitivity analyses confirmed low (<5%) probabilities of cost-effectiveness at current prices.
CONCLUSIONS: Adding SGLT2i or GLP-1 receptor agonists to standard care for Thai patients with T2DM and ASCVD is not cost-effective in Thailand under current pricing. To improve affordability and support inclusion in the NLEM, policy strategies should include price negotiation, risk-sharing agreements, and targeted reimbursements for high-risk subgroups. Additional pricing tools such as health technology-based tiered pricing, volume-based discount agreements, or cost-cap mechanisms should be considered to enhance affordability and reduce budget impact for public payers.
METHODS: A semi-Markov model was employed to estimate lifetime health outcomes and societal costs of adding SGLT2i (i.e. dapagliflozin, empagliflozin, and canagliflozin) or GLP-1 receptor agonists (semaglutide) to SoC versus SoC alone. Model inputs were derived from subgroup analyses of randomized control trials, national administrative databases, hospital records, and patient-reported data. Outcomes were measured in quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs), assessed against Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (USD 4,916) per QALY. Costs and outcomes were discounted at 3% annually, and parameter uncertainty was explored through deterministic and probabilistic sensitivity analyses.
RESULTS: Compared to SoC, canagliflozin generated the greatest QALYs gain (0.45), followed by dapagliflozin (0.26), pooled SGLT2i (0.22), semaglutide (0.13), and empagliflozin (0.10). ICERs per QALY gained were USD 10,442 (canagliflozin), USD 15,154 (dapagliflozin), USD 17,470 (pooled SGLT2i), USD 34,834 (empagliflozin), and USD 130,262 (semaglutide), all exceeding the national WTP threshold. Sensitivity analyses confirmed low (<5%) probabilities of cost-effectiveness at current prices.
CONCLUSIONS: Adding SGLT2i or GLP-1 receptor agonists to standard care for Thai patients with T2DM and ASCVD is not cost-effective in Thailand under current pricing. To improve affordability and support inclusion in the NLEM, policy strategies should include price negotiation, risk-sharing agreements, and targeted reimbursements for high-risk subgroups. Additional pricing tools such as health technology-based tiered pricing, volume-based discount agreements, or cost-cap mechanisms should be considered to enhance affordability and reduce budget impact for public payers.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE297
Topic
Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)