OBJECTIVES: The clinical goal in the treatment of T2D is to achieve reasonable glycemia control with minimal hypoglycemia and other side effects to avoid micro- and macrovascular complications. The study aimed to assess the long-term cost-effectiveness of oral semaglutide for the treatment of patients with T2D with inadequate glycemic control on metformin.

METHODS: The intervention is oral semaglutide and the comparators were empagliflozin, sitagliptin, liraglutide, and dulaglutide in different settings of T2D patients with HbA1c >8.5% and BMI >27kg/m² and for patients with high CV risk. The healthcare payer perspective in Taiwan was used in study.

Cost-effectiveness analyses were performed using the IQVIA CORE Diabetes Model. The baseline characteristics of different cohorts were obtained from real-world data. The cycle length of 1-year and a lifetime horizon was used. The annual discount rate is 3.0%. Treatment effect data were taken from the PIONEER trials. The direct medical cost of diabetes-related complications and adverse event costs were obtained from the National Health Insurance claims data. Utilities and disutilities of complications and adverse events were obtained from published studies.

RESULTS: Compared with empagliflozin, sitagliptin, liraglutide, and dulaglutide, the ICER per QALY gained of oral semaglutide were US$36,939.3, US$74,084.5, US$17,491.6, and US$10,775.3, respectively. When using 3 times GDP per capita in 2022 as the willingness-to-pay threshold, the probability of oral semaglutide being cost-effective were 85.8% (vs. empagliflozin), 56.2% (vs. sitagliptin), 80.8% (vs. liraglutide), and 56.2% (vs. dulaglutide).

Compared with liraglutide and dulaglutide, the ICER per QALY gained of oral semaglutide were US$22,779.1 and US$39,274.7. The probability of oral semaglutide being cost-effective was 69.3% (vs. liraglutide) and 52.9% (vs. dulaglutide) for patient with high CV risk.

CONCLUSIONS: Oral semaglutide has the potential to be a cost-effective option for the second-line treatment of T2D patients with obesity and uncontrolled glycemia and with major CV event.