OBJECTIVES: Dipeptidyl peptidase 4 inhibitors are established incretin-based oral therapy for management of hyperglycemia in type 2 diabetes with sitagliptin being the most commonly prescribed drug in this class. Recently, another oral incretin-based therapy (oral glucagon-like peptide 1 receptor agonist semaglutide) was also approved for use in the same population. We estimated the budget impact of utilizing oral semaglutide vs. sitagliptin as second line agent from a US payer perspective.

METHODS: Using the validated IQVIA CORE Diabetes Model, the impact of treatment was simulated over a 5-year time horizon. The model captured clinical and drug costs and clinical trial data informed cohort characteristics and treatment effects. Published data on healthcare utilization costs, population estimates and current diabetes therapy treatment patterns was used. Net costs for oral semaglutide and sitagliptin were based on the recent Institute for Clinical and Economic Review (ICER) report assessing oral semaglutide. The budget impact analysis estimated additional costs associated with oral semaglutide instead of sitagliptin for a US payer covering 1 million lives and for the total US population.

RESULTS: In a hypothetical plan of 1 million patient lives, 13,134 patients would currently be on second-line treatment with 1,988 using sitagliptin. Over a 5-year time horizon, each 10% increase in the use of oral semaglutide instead of sitagliptin would result in an additional cost of $3.4M for a US payer. Extrapolating to the additional cost for the entire US population, the value would be $1.2B. Switching 50% of sitagliptin patients to oral semaglutide would yield costs of $17.1 M for the hypothetical plan and $5.6B for the US population.

CONCLUSIONS: Use of oral semaglutide instead of sitagliptin results in substantial incremental costs to a US payer over a 5-year time horizon.