Evaluation of the Long-Term Cost-Effectiveness of Once-Weekly Semaglutide Versus Dulaglutide and Sitagliptin in the Spanish Setting.

Abstract

Healthcare systems aim to maximize the health of the population, but must work within constrained budgets. Therefore, choosing therapies that are both effective and cost-effective is paramount. The present analysis assessed the cost-effectiveness of once-weekly semaglutide 0.5mg and 1mg versus once-weekly dulaglutide 1.5mg and versus once daily sitagliptin 100mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications over patient lifetimes from a healthcare payer perspective in the Spanish setting. Cost and clinical outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline cohort characteristics and treatment effects on initiation of semaglutide 0.5mg and 1mg, dulaglutide 1.5mg and sitagliptin 100mg were based on the once-weekly semaglutide clinical trial program (SUSTAIN 7 and 2). Captured costs included treatment costs and costs of diabetes-related complications. Projected outcomes were discounted at 3.0% annually. Projections of long-term clinical outcomes indicated that once-weekly semaglutide 0.5mg and 1mg were associated with improvements in discounted life expectancy of 0.02 and 0.11years, respectively, and discounted quality-adjusted life expectancy of 0.03 and 0.11quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5mg. Compared with sitagliptin, once-weekly semaglutide 0.5mg and 1mg were associated with improvements in discounted life expectancy of 0.17 and 0.24years, respectively and discounted quality-adjusted life expectancy of 0.16 and 0.23QALYs. The increased duration and quality of life with once-weekly semaglutide 0.5mg and 1mg resulted from a reduced cumulative incidence and delayed time to onset of diabetes-related complications. Avoided complications resulted in once-weekly semaglutide 0.5mg and 1mg being cost-saving versus dulaglutide 1.5 mg and versus sitagliptin 100mg from a healthcare payer perspective. Once-weekly semaglutide 0.5mg and 1mg were considered dominant (more effective and less costly) versus sitagliptin 100mg and dulaglutide 1.5mg for the treatment of patients with type 2 diabetes with inadequate glycemic control on oral anti-hyperglycemic medications and are likely to be a good use of healthcare resources in the Spanish setting.