Cost-effectiveness of oral semaglutide added to current antihyperglycemic treatment for type 2 diabetes

BACKGROUND: Oral semaglutide is the first oral formulation of a glucagon-like peptide 1 (GLP-1) receptor agonist to be approved in United States for glycemic control people with type 2 diabetes mellitus (T2DM). While not indicated reduction cardiovascular event risk, its label does include evidence no increase risk who received semaglutide. OBJECTIVE: To estimate incremental value added existing antihyperglycemic treatment T2DM additional disease. METHODS: We estimated lifetime cost-effectiveness current using microsimulation model based primarily on UK Prospective Diabetes Study (UKPDS) Outcomes Model (OM2) equations. was separately compared (a) ongoing background treatment, (b) sitagliptin, (c) empagliflozin, and (d) liraglutide. Comparators liraglutide were treatment. applied hazard ratios derived from network meta-analysis renal outcomes UKPDS OM2 baseline rates. Health state utilities costs published literature. total costs, life-years (LYs), quality-adjusted (QALYs), clinical events, cost per major adverse (MACE) avoided, over time horizon discount rates 3% outcomes. RESULTS: The treated $311,300, other comparators ranging $262,800 (background alone) $287,800 (liraglutide). resulted fewest MACE, including deaths. Among 5 modeled strategies, had highest LYs gained (8.43 vs. 7.76 [background alone] 8.29 [empagliflozin liraglutide]) QALYs (4.11 3.70 4.03 [empagliflozin]). would likely considered cost-effective (incremental ratio [ICER] = $40,100), moderately versus alone ([ICER] $117,500/QALY) sitagliptin (ICER $145,200/QALY). ICER empagliflozin approximately $458,400 QALY. CONCLUSIONS: As modeled, as an add-on therapy produced benefits MACE along greater alone. use better than or similar overlapping 95% confidence ranges QALYs. have between $100,000 $150,000 QALY alone, but it did meet these thresholds empagliflozin. DISCLOSURES: Funding this study provided by Institute Clinical Economic Review, independent organization that evaluates health care interventions. reports grants Laura John Arnold Foundation, California Care Harvard Pilgrim Care, Kaiser Foundation Plan. ICER’s annual policy summit supported dues AbbVie, Aetna, America’s Insurance Plans, Anthem, Alnylam, AstraZeneca, Biogen, Blue Shield CA, Cambia Services, CVS, Editas, Evolve Pharmacy, Express Scripts, Genentech/Roche, GlaxoSmithKline, Pilgrim, Service Corporation, Partners, Humana, Johnson & (Janssen), Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark uniQure, Healthcare. Rind, Fazioli, Chapman, Pearson are employed ICER. Guzauskas Hansen nothing disclose. results presented at New England Comparative Effectiveness Public Advisory Council (New CEPAC), November 14, 2019, Brown University, Providence, RI.