OBJECTIVES : Glucagon-like peptide-1 (GLP-1) receptor agonists are appealing as glucose-lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with lower rates of hypoglycemia. This study assessed the long-term cost-effectiveness of two once-weekly GLP-1 receptor agonists from the payer’s perspective.

METHODS : In this study, target population was T2DM patients who could not achieve glycemic control with metformin. Interventions were once-weekly semaglutide 0.5mg and 1.0mg; comparator was dulaglutide 1.5mg. Long-term outcomes include direct medical costs, survival, life expectancy, quality-adjusted life-expectancy (QALE), the cumulative incidence of diabetes-related complications, and time to onset of diabetes-related complications.

This study used the IQVIA CORE Diabetes Model (version 9.0) with a time horizon of 50 years. Baseline cohort characteristics, changes in physiological parameters and adverse event rates were derived from the 40-week SUSTAIN 7 trial. Direct medical costs were assessed to capture the costs of pharmaceutical costs and complications. Utilities were taken from published sources. Both one-way and probabilistic sensitivity analyses and scenario analyses were used to incorporate uncertainty.

RESULTS : Once-weekly semaglutide 0.5 and 1.0 mg were associated with increasing 0.03 and 0.08 QALE, respectively, compared with dulaglutide 1.5 mg. Lifetime costs were saved at $83 with once-weekly semaglutide 0.5 mg and $239 with 1.0 mg, resulting from fewer diabetes-related complications due to better glycemic control. Therefore, both doses of once-weekly semaglutide were considered dominant vs dulaglutide 1.5 mg. When the willingness-to-pay threshold was set at 1 GDP per capita ($25,792 in 2018 in Taiwan) per QALE gained, the probabilities of semaglutide being cost-effectiveness were 60.1% for 0.5 mg and 76.5% for 1.0 mg.

CONCLUSIONS : Compared with dulaglutide, once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM who could not achieve glycemic control with metformin to both improve clinical outcomes and reduce costs.