OBJECTIVES: Once-weekly semaglutide resulted in greater reductions in glycated hemoglobin (HbA1c) and body weight than dulaglutide in patients with type 2 diabetes uncontrolled on metformin in the SUSTAIN 7 clinical trial. Reductions in HbA1c and body weight reduce the risk of long-term diabetes-related complications. The aim of the present analysis was to assess the long-term cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus dulaglutide 1.5 mg in Portugal.

METHODS: Long-term projections of clinical and cost outcomes were performed with the IQVIA CORE Diabetes Model over a 50-year time horizon. Baseline cohort characteristics and treatment effects were sourced from SUSTAIN 7. Costs were expressed in Euros (EUR) and estimated from a healthcare payer perspective. Quality-of-life utilities were obtained from published sources. Sensitivity analyses were performed.

RESULTS: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.02 and 0.09 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg, resulting from reduced cumulative incidence and delayed time to onset of diabetes-related complications. Total direct costs with once-weekly semaglutide 0.5 mg and 1 mg were EUR 130 and EUR 140 higher than with dulaglutide 1.5 mg over patient lifetimes, with higher acquisition costs partially offset by cost savings due to avoidance of complications. Once-weekly semaglutide 0.5 mg and 1 mg were therefore associated with incremental cost-effectiveness ratios of EUR 7,202 and EUR 1,490 per QALY gained, respectively, versus dulaglutide 1.5 mg. These results were confirmed in sensitivity analyses.

CONCLUSIONS: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg are likely to provide good value for money versus dulaglutide 1.5 mg for the treatment of patients with type 2 diabetes not achieving glycemic control on metformin in Portugal.