The Management of Type 2 Diabetes with Once-Weekly Semaglutide Versus Dulaglutide: A Long-Term Cost-Effectiveness Analysis in Slovakia

Samuel J P Malkin, Monika Russel-Szymczyk, Marek Psota, Lucia Hlavinkova, Barnaby Hunt, Samuel J P Malkin, Monika Russel-Szymczyk, Marek Psota, Lucia Hlavinkova, Barnaby Hunt

Abstract

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists represent a class of treatments for type 2 diabetes that offer multifactorial benefits, including glycemic control, weight loss and low hypoglycemia risk. Once-weekly semaglutide is a novel GLP-1 analog that has been associated with improved glycemic control and reduced body mass index (BMI) versus once-weekly GLP-1 receptor agonist dulaglutide in SUSTAIN 7, which is reimbursed in patients with a BMI > 35 kg/m2 in Slovakia. The aim of the present study was to evaluate the long-term cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus dulaglutide 1.5 mg in Slovakia.

Methods: Clinical and cost outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Baseline cohort characteristics and treatment effects were based on the sub-group of patients with a BMI > 35 kg/m2 in SUSTAIN 7. Patients were modeled to receive once-weekly semaglutide or dulaglutide for 3 years, after which treatment was intensified to basal insulin. Treatment effects associated with once-weekly semaglutide and dulaglutide were maintained for the first 3 years before HbA1c increased to 7.0% and BMI reverted to baseline. Costs were accounted from a healthcare payer perspective in Slovakia and expressed in euros (EUR). Utilities relating to quality of life were taken from published sources.

Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.04 and 0.07 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg. Lifetime medical costs were similar, with cost savings of EUR 20 and EUR 140 per patient with once-weekly semaglutide 0.5 mg and 1 mg, respectively, versus dulaglutide 1.5 mg. Both doses of once-weekly semaglutide were therefore considered dominant versus dulaglutide 1.5 mg.

Conclusion: Both doses of once-weekly semaglutide represent cost-saving treatment options versus dulaglutide 1.5 mg for obese patients with type 2 diabetes in Slovakia.

Funding: Novo Nordisk A/S.

Keywords: Cost; Cost-effectiveness; Diabetes mellitus; Dulaglutide; GLP-1 analog; GLP-1 receptor agonist; Semaglutide; Slovakia.

Figures

Fig. 1
Fig. 1
Mean time to onset of diabetes-related complications
Fig. 2
Fig. 2
Direct costs over patient lifetimes. EUR, euros
Fig. 3
Fig. 3
Probabilistic sensitivity analysis scatterplot. EUR, euros; QALY, quality-adjusted life year. Based on a willingness-to-pay threshold of EUR 25,536 per QALY gained (the lowest possible threshold for an intervention in 2018, 28 times the average monthly wage in Slovakia), the modeling analysis indicated that the probabilities of once-weekly semaglutide 0.5 mg and 1 mg being cost-effective were 57.1% and 72.4%, respectively, versus dulaglutide 1.5 mg

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