OBJECTIVES: This study assessed whether two-years treatment with semaglutide 2.4 mg, in combination with diet and exercise (D&E), is cost-effective compared to D&E alone, in adults with body mass index (BMI) ≥ 30 kg/m² and one or more weight-related comorbidity, taking a healthcare payer perspective, assuming a lifetime horizon and a 4% discount rate.

METHODS: The cost-utility analysis was performed using the Core Obesity Model, a Markov model designed to evaluate costs and health outcomes of developing obesity complications as a function of risk factors (i.e, BMI, lipids, SBP and glycaemic status), using data from STEP 1 trial. Baseline utility was sourced from SF‑36 instrument’s data from STEP 1 trial and mapped to SF‑6D using country‑specific preferences. Regression analyses were estimated to inform changes in utility as a function of BMI. Portuguese-specific disease management resource use was based on clinical experts’ panels and Portuguese diagnosis-related group microdata. National legislation and official drug cost databases were the main sources for unit costs. One-way and scenario analyses were conducted to assess the main drivers of the model. Probabilistic sensitivity analyses were conducted to assess the robustness of results.

RESULTS: Trial-observed differences in risk factors were projected and resulted in reductions of the occurrence of further obesity complications and associated costs, translating into LY gains (+0.078), QALY gains (+0.098) and cost savings of -546€ per patient, compensating the additional treatment cost of +1,870€. Accordingly, the incremental cost-utility ratio (ICUR) was estimated at 13,459€ per QALY. All one-way and scenario analyses resulted in ICUR below 20,000€ per QALY and probabilistic analyses showed a 100% probability of semaglutide being cost-effective at this threshold.

CONCLUSIONS: Analyses demonstrate, with robustness, that semaglutide is a cost‑effective treatment option for chronic weight management, compared to D&E alone.