OBJECTIVES: A number of people with type 2 diabetes experience clinical inertia, remaining in poor glycaemic control on oral antidiabetic medications such as metformin and sodium-glucose cotransporter-2 (SGLT-2) inhibitors rather than treatment-intensifying with a glucagon-like peptide-1 receptor agonist, despite an efficacious, orally administered option, oral semaglutide, being available. The present study evaluated the long-term cost-effectiveness of immediate oral semaglutide treatment versus continuing metformin plus SGLT-2 inhibitor therapy in the UK.

METHODS: Outcomes were projected over patients’ lifetimes using the IQVIA CORE Diabetes Model (v9.0). Clinical data were taken from the oral semaglutide and placebo arms of the patient subgroup receiving metformin plus an SGLT-2 inhibitor in PIONEER 4. Modelled patients received oral semaglutide immediately or after a 2-year delay, after which all physiological parameters were brought to the values observed in the immediate therapy arm. A clinically realistic treatment algorithm was followed, with patients intensifying with the addition of basal insulin and, subsequently, by switching to basal-bolus insulin. Costs were expressed in 2021 pounds sterling (GBP) and accounted from a healthcare payer perspective.

RESULTS: Immediate oral semaglutide therapy was associated with improvements in life expectancy of 0.17 years, and quality-adjusted life expectancy of 0.15 quality-adjusted life years (QALYs), versus a 2-year delay. Benefits were due to a reduced incidence of diabetes-related complications with immediate oral semaglutide. Direct costs were estimated to be GBP 1,423 higher with immediate oral semaglutide therapy versus a 2-year delay, with higher treatment costs partially offset by cost savings from avoidance of diabetes-related complications. Immediate oral semaglutide therapy was therefore associated with an incremental cost-effectiveness ratio of GBP 9,404 per QALY gained versus a 2-year delay.

CONCLUSIONS: Immediate oral semaglutide therapy represents a highly cost-effective treatment option in people with type 2 diabetes with inadequate glycaemic control on metformin plus an SGLT-2 inhibitor in the UK.