Josep Franch-Nadal1,2, Samuel J P Malkin3, Barnaby Hunt4, Virginia Martín5, María Gallego Estébanez5, Josep Vidal1,6. 1. Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. 2. Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain. 3. Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland. malkin@ossianconsulting.com. 4. Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland. 5. Novo Nordisk Pharma SA, Madrid, Spain. 6. Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain.
Abstract
INTRODUCTION: Novel glucagon-like peptide-1 (GLP-1) receptor agonist oral semaglutide has demonstrated greater improvements in glycated hemoglobin (HbA1c) and body weight versus oral medications empagliflozin and sitagliptin, and injectable GLP-1 analog liraglutide, in the PIONEER clinical trial program. Based on these data, the present analysis aimed to evaluate the long-term cost-effectiveness of oral semaglutide versus empagliflozin, sitagliptin and liraglutide in Spain. METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 3.0% annually. Cohort characteristics and treatment effects were sourced from PIONEER 2 and 4 for the comparisons of oral semaglutide 14 mg versus empagliflozin 25 mg and liraglutide 1.8 mg, respectively, and PIONEER 3 for oral semaglutide 7 and 14 mg versus sitagliptin 100 mg. Costs were accounted from a healthcare payer perspective in 2020 euros (EUR). Patients were assumed to receive initial therapies until HbA1c exceeded 7.5% and then treatment-intensified to basal insulin. RESULTS: Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.13, 0.19 and 0.06 quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with direct costs EUR 168 higher versus empagliflozin and EUR 236 and 1415 lower versus sitagliptin and liraglutide, respectively. Oral semaglutide 14 mg was associated with an incremental cost-effectiveness ratio (ICER) of EUR 1339 per QALY gained versus empagliflozin and was considered dominant (clinically superior and cost saving) versus sitagliptin and liraglutide. Additional analyses demonstrated that oral semaglutide 7 mg was associated with improvements of 0.11 QALYs and increased costs of EUR 226 versus sitagliptin and was therefore associated with an ICER of EUR 2011 per QALY gained. CONCLUSION: Oral semaglutide 14 mg was dominant versus sitagliptin and liraglutide, and cost-effective versus empagliflozin, for the treatment of type 2 diabetes in Spain.
INTRODUCTION: Novel glucagon-like peptide-1 (GLP-1) receptor agonist oral semaglutide has demonstrated greater improvements in glycated hemoglobin (HbA1c) and body weight versus oral medications empagliflozin and sitagliptin, and injectable GLP-1 analog liraglutide, in the PIONEER clinical trial program. Based on these data, the present analysis aimed to evaluate the long-term cost-effectiveness of oral semaglutide versus empagliflozin, sitagliptin and liraglutide in Spain. METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0), discounted at 3.0% annually. Cohort characteristics and treatment effects were sourced from PIONEER 2 and 4 for the comparisons of oral semaglutide 14 mg versus empagliflozin 25 mg and liraglutide 1.8 mg, respectively, and PIONEER 3 for oral semaglutide 7 and 14 mg versus sitagliptin 100 mg. Costs were accounted from a healthcare payer perspective in 2020 euros (EUR). Patients were assumed to receive initial therapies until HbA1c exceeded 7.5% and then treatment-intensified to basal insulin. RESULTS: Oral semaglutide 14 mg was associated with improvements in quality-adjusted life expectancy of 0.13, 0.19 and 0.06 quality-adjusted life years (QALYs) versus empagliflozin 25 mg, sitagliptin 100 mg and liraglutide 1.8 mg, respectively, with direct costs EUR 168 higher versus empagliflozin and EUR 236 and 1415 lower versus sitagliptin and liraglutide, respectively. Oral semaglutide 14 mg was associated with an incremental cost-effectiveness ratio (ICER) of EUR 1339 per QALY gained versus empagliflozin and was considered dominant (clinically superior and cost saving) versus sitagliptin and liraglutide. Additional analyses demonstrated that oral semaglutide 7 mg was associated with improvements of 0.11 QALYs and increased costs of EUR 226 versus sitagliptin and was therefore associated with an ICER of EUR 2011 per QALY gained. CONCLUSION: Oral semaglutide 14 mg was dominant versus sitagliptin and liraglutide, and cost-effective versus empagliflozin, for the treatment of type 2 diabetes in Spain.
Authors: Faramarz Ismail-Beigi; Timothy Craven; Mary Ann Banerji; Jan Basile; Jorge Calles; Robert M Cohen; Robert Cuddihy; William C Cushman; Saul Genuth; Richard H Grimm; Bruce P Hamilton; Byron Hoogwerf; Diane Karl; Lois Katz; Armand Krikorian; Patrick O'Connor; Rodica Pop-Busui; Ulrich Schubart; Debra Simmons; Harris Taylor; Abraham Thomas; Daniel Weiss; Irene Hramiak Journal: Lancet Date: 2010-06-30 Impact factor: 79.321
Authors: Helena W Rodbard; Julio Rosenstock; Luis H Canani; Chaicharn Deerochanawong; Janusz Gumprecht; Søren Østergaard Lindberg; Ildiko Lingvay; Anette Luther Søndergaard; Marianne Bach Treppendahl; Eduard Montanya Journal: Diabetes Care Date: 2019-09-17 Impact factor: 19.112
Authors: Christoph Stettler; Sabin Allemann; Peter Jüni; Carole A Cull; Rury R Holman; Matthias Egger; Stephan Krähenbühl; Peter Diem Journal: Am Heart J Date: 2006-07 Impact factor: 4.749
Authors: Julio Rosenstock; Dale Allison; Andreas L Birkenfeld; Thalia Marie Blicher; Srikanth Deenadayalan; Jacob Bonde Jacobsen; Pierre Serusclat; Rafael Violante; Hirotaka Watada; Melanie Davies Journal: JAMA Date: 2019-04-16 Impact factor: 56.272
Authors: Rury R Holman; Sanjoy K Paul; M Angelyn Bethel; David R Matthews; H Andrew W Neil Journal: N Engl J Med Date: 2008-09-10 Impact factor: 91.245