Assessing the cost-effectiveness of a once-weekly GLP-1 analogue versus an SGLT-2 inhibitor in the Spanish setting: Once-weekly semaglutide versus empagliflozin

Abstract

Aims: Controlling costs while maximizing healthcare gains is the predominant challenge for healthcare providers, and therefore cost-effectiveness analysis is playing an ever-increasing role in healthcare decision making. The aim of the present analysis was to assess the long-term cost-effectiveness of subcutaneous once-weekly semaglutide (0.5 mg and 1 mg) versus empagliflozin (10 mg and 25 mg) in the Spanish setting for the treatment of patients with type 2 diabetes (T2D) with inadequate glycemic control on oral anti-hyperglycemic medications.

Material and methods: The IQVIA CORE Diabetes Model was used to project outcomes over patient lifetimes with once-weekly semaglutide versus empagliflozin, with treatment effects based on a network meta-analysis. The analysis captured treatment costs, costs of diabetes-related complications, and the impact of complications on quality of life, based on published sources. Outcomes were discounted at 3.0% per annum.

Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted quality-adjusted life expectancy of 0.12 and 0.15 quality-adjusted life years (QALYs), respectively, versus empagliflozin 10 mg and improvements of 0.11 and 0.14 QALYs, respectively, versus empagliflozin 25 mg. Treatment costs were higher with once-weekly semaglutide compared with empagliflozin, but this was partially offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 0.5 mg and 1 mg were associated with incremental cost-effectiveness ratios of EUR 2,285 and EUR 161 per QALY gained, respectively, versus empagliflozin 10 mg, and EUR 3,090 and EUR 625 per QALY gained, respectively, versus empagliflozin 25 mg.

Conclusions: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg were projected to be cost-effective versus empagliflozin 10 mg and 25 mg for the treatment of patients with T2D with inadequate glycemic control on oral anti-hyperglycemic medications in the Spanish setting, irrespective of patients’ BMI at baseline.

Keywords:

• Cost
• cost-effectiveness
• type 2 diabetes mellitus
• empagliflozin
• GLP-1 receptor agonist
• GLP-1 analogue
• semaglutide
• SGLT-2 inhibitor

JEL CLASSIFICATION CODES:

• I19
• I10

Transparency

Declaration of funding

The present cost-effectiveness analysis and article processing charges were supported by funding from Novo Nordisk A/S.

Declaration of financial/other interests

Juan José Gorgojo-Martínez has the following financial relationships: advisor on scientific boards for AstraZeneca, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme, Mundipharma, Novo Nordisk and Pfizer; lectures for Abbott, AbbVie Inc, AstraZeneca, Boehringer Ingelheim Pharmaceuticals Inc, Esteve, Janssen Pharmaceuticals, Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Roche Pharma and Sanofi Aventis, and research activities for AstraZeneca, Novo Nordisk and Sanofi Aventis. Virginia Martín is an employee of Novo Nordisk Pharma SA. Nino Hallén is an employee of Novo Nordisk A/S. Samuel Malkin and Barnaby Hunt are employees of Ossian Health Economics and Communications, which received consulting fees from Novo Nordisk A/S to support the preparation of the analysis. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

The study was conceived and designed by Barnaby Hunt and Virginia Martín. Data were collected by Barnaby Hunt, Sam Malkin, and Virginia Martín. The analysis was performed by Barnaby Hunt. The manuscript was written by Juan José Gorgojo-Martínez, Samuel Malkin, Virginia Martín, Nino Hallén and Barnaby Hunt.

Acknowledgements

No assistance in the preparation of this article is to be declared.

Previous presentations

This analysis has not been presented previously.