LIFETIME CLINICAL AND ECONOMIC IMPACT OF EARLY VERSUS DELAYED GLP-1 RECEPTOR AGONIST INITIATION ACROSS RISK-STRATIFIED TYPE 2 DIABETES POPULATIONS IN THE UAE: A CORE DIABETES MODEL ANALYSIS
Author(s)
Khuloud Rafeea, Pharmacist1, Sahar Famy, Pharmacist1, Hatem Abueida, Medical Doctor2, Hani Sabbour, Medical Doctor3, Tarek Fiad, Medical Doctor4, Bahaa Shaath, Medical Doctor5, Sami Abdalla Morsy, Medical Doctor6, Nagwa Wahdan, Pharmacist7, Yacine Amirouche, Pharmacist7, Basem Elbramawy, Pharmacist7, Nancy Awad, Pharmacist8.
1Department of Health Abu Dhabi, Al Ain, United Arab Emirates, 2ISPOR UAE Chapter, Abu Dhabi, United Arab Emirates, 3Mediclinic, Abu Dhabi, United Arab Emirates, 4Shaikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 5Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates, 6Burjeel, Abu Dhabi, United Arab Emirates, 7Novo Nordisk, Abu Dhabi, United Arab Emirates, 8Masdar Al Hekmah, Riyadh, Saudi Arabia.
1Department of Health Abu Dhabi, Al Ain, United Arab Emirates, 2ISPOR UAE Chapter, Abu Dhabi, United Arab Emirates, 3Mediclinic, Abu Dhabi, United Arab Emirates, 4Shaikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, 5Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates, 6Burjeel, Abu Dhabi, United Arab Emirates, 7Novo Nordisk, Abu Dhabi, United Arab Emirates, 8Masdar Al Hekmah, Riyadh, Saudi Arabia.
OBJECTIVES: Type 2 diabetes mellitus imposes a substantial clinical and economic burden in the United Arab Emirates (UAE), affecting ~1.27 million adults. Although GLP-1 receptor agonists provide proven benefits in disease control, access remains restricted to specialist care, limiting timely initiation in primary care and contributing to worse outcomes. The objective is to assess outcomes of early versus delayed GLP-1 receptor agonist initiation across three T2DM risk cohorts in the UAE.
METHODS: IQVIA Core Diabetes Model was used (lifetime horizon, 3% discount rate, societal and payer perspectives, UAE-adapted). Three cohorts were modelled: Very High Risk (HbA1c 9.2%, age 56, 12-year T2DM duration), Moderate-to-High Risk (HbA1c 8.28%, age <50 with >2 risk factors or >50 with ≤1 risk factor; 8.46-year duration), and Low Risk (HbA1c 7.25%, <50 years with ≤1 risk factor; recently diagnosed). GLP-1 receptor agonist was compared with metformin, DPP-4 and SGLT2 inhibitors. Six scenarios compared standard of care alone versus add-on semaglutide initiated at Years 1, 3, 6, 9, 13.
RESULTS: Early GLP-1 initiation improved outcomes across cohorts. In Years 1 and 3, life expectancy increased by 9.3-9.7% and QALYs by 12.6-13.0% in the Very High-Risk group; 6.16-6.34% and 8.13-8.26% in the Moderate-to-High Risk group; and 5.17-5.32% and 6.7% in the Low-Risk group, with smaller gains in later initiation years. Direct costs increased, while indirect and complication costs decreased. Cost per QALY decreased with early initiation (Very High-risk group: −3.2% Y1, −1.6% Y3; Moderate-to-High Risk group: −2.26% Y1-Y3; Low risk group: −1.19% Y1) and rose with delayed initiation. Cardiovascular, renal, and ocular complications declined, with a mild increase in severe hypoglycemia in high-risk groups.
CONCLUSIONS: Early GLP-1 initiation improves long-term clinical outcomes with a more favorable cost-effectiveness profile than delayed initiation, supporting expanded prescribing rights for primary care general physicians in the UAE.
METHODS: IQVIA Core Diabetes Model was used (lifetime horizon, 3% discount rate, societal and payer perspectives, UAE-adapted). Three cohorts were modelled: Very High Risk (HbA1c 9.2%, age 56, 12-year T2DM duration), Moderate-to-High Risk (HbA1c 8.28%, age <50 with >2 risk factors or >50 with ≤1 risk factor; 8.46-year duration), and Low Risk (HbA1c 7.25%, <50 years with ≤1 risk factor; recently diagnosed). GLP-1 receptor agonist was compared with metformin, DPP-4 and SGLT2 inhibitors. Six scenarios compared standard of care alone versus add-on semaglutide initiated at Years 1, 3, 6, 9, 13.
RESULTS: Early GLP-1 initiation improved outcomes across cohorts. In Years 1 and 3, life expectancy increased by 9.3-9.7% and QALYs by 12.6-13.0% in the Very High-Risk group; 6.16-6.34% and 8.13-8.26% in the Moderate-to-High Risk group; and 5.17-5.32% and 6.7% in the Low-Risk group, with smaller gains in later initiation years. Direct costs increased, while indirect and complication costs decreased. Cost per QALY decreased with early initiation (Very High-risk group: −3.2% Y1, −1.6% Y3; Moderate-to-High Risk group: −2.26% Y1-Y3; Low risk group: −1.19% Y1) and rose with delayed initiation. Cardiovascular, renal, and ocular complications declined, with a mild increase in severe hypoglycemia in high-risk groups.
CONCLUSIONS: Early GLP-1 initiation improves long-term clinical outcomes with a more favorable cost-effectiveness profile than delayed initiation, supporting expanded prescribing rights for primary care general physicians in the UAE.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE16
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)