OBJECTIVES: The prevalence of type 2 diabetes (T2D) in Saudi Arabia is one of the top ten prevalences globally, which imposes a substantial economic burden on the healthcare system. Glucagon-like peptide-1 agonists (GLP-1) are one of the novel treatments for diabetes. The research aims to determine whether Semaglutide 1.0 mg is cost-effective compared with Dulaglutide 1.5 mg from a Saudi public payer perspective.

METHODS: A literature review was conducted to acquire the input parameters based on the available literature that could populate the cost-utility model to inform the Saudi decision-makers better. A literature review was developed to inform the cost-utility analysis (CUA) with the structure of the Markov model in terms of health states that could describe the patient journey, baseline risks that could simulate the patients' movements among the different health states, and clinical outcomes for the comparators, health utilities, and cost data. The second phase was developing the CUA based on the available literature, including only direct medical costs for ten years time horizon. The Incremental Net Monetary Benefit (INMB) was estimated based on the Saudi cost-effectiveness threshold (CET) of 50,000 SAR – 75,000 SAR. Structural and parameter uncertainties were explored by developing sensitivity and scenario analyses.

RESULTS: Semaglutide 1.0 mg was dominant in the base case analysis with incremental 0.11 QALY, - 3,175 SAR. INMB ranged from 8,671 SAR to 11,419 SAR on the lower and upper bounds of the CET range, respectively. Semaglutide 1.0 mg sustained the results in all scenarios. One-way sensitivity analysis illustrated that the key drivers of the cost-effectiveness findings are treatment acquisition cost, the proportion of patients achieving HbA1C%, and hazard ratios of developing cardiovascular complications.

CONCLUSIONS: At the current prices, Semaglutide 1.0 mg is cost-effective compared with Dulaglutide 1.5 mg when the model considered macrovascular complications and chronic kidney disease (CKD).