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

Figures & data

Table 1. Treatment effects applied in the first year of the analysis.

Parameter	Once-weekly semaglutide 0.5 mg	Once-weekly semaglutide 1 mg	Empagliflozin 10 mg	Empagliflozin 25 mg
HbA1c (%)	−1.23 (0.10)*^,†	−1.42 (0.09)*^,†	−0.59 (0.07)	−0.62 (0.07)
Systolic blood pressure (mmHg)	−6.73 (1.36)	−7.28 (1.37)	−4.09 (2.08)	−4.80 (2.43)
BMI (kg/m^2)	−1.00 (0.14)*	−1.49 (0.14)*^,†	−0.58 (0.09)	−0.74 (0.08)

Abbreviations. BMI, body mass index; HbA1c, glycated hemoglobin. Values are means (standard error). *Statistically significant difference at 95% confidence level versus empagliflozin 10 mg (p values not presented by Sharma et al.²³). ^†Statistically significant difference at 95% confidence level versus empagliflozin 25 mg (p values not presented by Sharma et al.²³).

Table 2. Costs of treating diabetes-related complications.

Complication	Cost (EUR)	Reference
Myocardial infarction, year of event	7,170	[54]
Myocardial infarction, years 2+	1,008	[55]
Angina, year of onset	4,027	[56]
Angina, years 2+	371	[55]
Congestive heart failure, year of onset	4,470	[57]
Congestive heart failure, years 2+	226	[55]
Stroke, year of event	7,108	[58]
Stroke, years 2+	638	[55]
Stroke, death within 30 days	3,862	[55]
Peripheral vascular disease, onset	6,750	[59]
Peripheral vascular disease, years 2+	6,750	[59]
Hemodialysis, onset	41,641	[60]
Hemodialysis, years 2+	41,831	[60]
Peritoneal dialysis, onset	20,596	[61]
Peritoneal dialysis, years 2+	20,378	[61]
Kidney transplant, first year	24,182	[62]
Kidney transplant, years 2+	5,364	[55]
Non-severe hypoglycemia	8	[63]
Severe hypoglycemia	1,088	[64]
Laser treatment	230	[65]
Cataract operation	3,664	[66]
Cataract operation, years 2+	101	[67]
Blindness, first year	3,027	[68]
Blindness, years 2+	101	[67]
Neuropathy, year of onset	6,219	[69]
Neuropathy, years 2+	6,219	[69]
Amputation, procedure	8,640	[70]
Amputation, prosthesis	7,658	[71]
Gangrene treatment	10,894	[72]
Infected foot ulcer	7,102	[73]
Uninfected foot ulcer	7,102	[73]
Cost after healed ulcer	56	[74]

Abbreviation. EUR, 2018 euros.

Figure 1. Mean time to onset of diabetes-related complications.

Table 3. Base case results.

	Once-weekly semaglutide 0.5 mg	Empagliflozin 10 mg	Empagliflozin 25 mg
Discounted life expectancy (years)	15.54 (0.20)^*,†	15.42 (0.21)	15.43 (0.21)
Discounted quality-adjusted life expectancy (QALYs)	10.29 (0.14)^*,†	10.17 (0.14)	10.18 (0.14)
Discounted direct costs (EUR)	68,707 (1,927)^*,†	68,436 (1,871)	68,372 (1,911)
ICER based on life expectancy and direct costs	–	EUR 2,138 per life year gained	EUR 2,853 per life year gained
ICER based on quality-adjusted life expectancy and direct costs	–	EUR 2,285 per QALY gained	EUR 3,090 per QALY gained
	Once-weekly semaglutide 1 mg	Empagliflozin 10 mg	Empagliflozin 25 mg
Discounted life expectancy (years)	15.58 (0.22)^*,†	15.42 (0.21)	15.43 (0.21)
Discounted quality-adjusted life expectancy (QALYs)	10.32 (0.15)^*,†	10.17 (0.14)	10.18 (0.14)
Discounted direct costs (EUR)	68,461 (2,012)	68,436 (1,871)	68,372 (1,911)
ICER based on life expectancy and direct costs	–	EUR 154 per life year gained	EUR 592 per life year gained
ICER based on quality-adjusted life expectancy and direct costs	–	EUR 161 per QALY gained	EUR 625 per QALY gained

Abbreviations. EUR, 2018 euros; ICER, incremental cost-effectiveness ratio; QALYs, quality-adjusted life years. Values are means (standard deviations). *Statistically significant difference at 95% confidence level versus empagliflozin 10 mg (p values not available as outputs from the IQVIA CORE Diabetes Model). †Statistically significant difference at 95% confidence level versus empagliflozin 25 mg (p values not available as outputs from the IQVIA CORE Diabetes Model).

Table 4. Key drivers of clinical outcomes with once-weekly semaglutide 1 mg.

Analysis	Difference in quality-adjusted life expectancy versus empagliflozin 10 mg (QALYs)	Difference in quality-adjusted life expectancy versus empagliflozin 25 mg (QALYs)
Base case analysis	+0.15*	+0.14^†
HbA1c difference only	+0.12*	+0.10^†
Blood pressure difference only	+0.04*	+0.02^†
BMI difference only	+0.04*	+0.04^†

Abbreviations. BMI, body mass index; HbA1c, glycated hemoglobin; QALY, quality-adjusted life year. *Statistically significant difference at 95% confidence level versus empagliflozin 10 mg (p values not available as outputs from the IQVIA CORE Diabetes Model). †Statistically significant difference at 95% confidence level versus empagliflozin 25 mg (p values not available as outputs from the IQVIA CORE Diabetes Model).

Table 5. Sensitivity analysis results.

Analysis	ICER for once-weekly semaglutide 1 mg versus empagliflozin 10 mg (EUR per QALY gained)	ICER for once-weekly semaglutide 1 mg versus empagliflozin 25 mg (EUR per QALY gained)
Base case	161	625
Statistically significant differences only	2,630	1,674
35-year time horizon	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
20-year time horizon	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
10-year time horizon	8,215	9,244
0% discount rates	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
5% discount rates	1,525	2,270
BMI difference maintained for patient lifetimes	155	361
UKPDS HbA1c creep for duration of the analysis (no change upon treatment intensification)	Once-weekly semaglutide dominant	942
Upper 95% CI of HbA1c estimated treatment difference	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
Lower 95% CI of HbA1c estimated treatment difference	4,144	5,599
Upper 95% CI of BMI estimated treatment difference	Once-weekly semaglutide dominant	153
Lower 95% CI of BMI estimated treatment difference	Once-weekly semaglutide dominant	218
Treatment switching after 5 years of treatment	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
Treatment switching at 7.5% HbA1c threshold (using UKPDS progression)	262	244
Cost of complications +10%	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
Cost of complications −10%	1,510	2,019
UKPDS 82 risk equations applied	Once-weekly semaglutide dominant	Once-weekly semaglutide dominant
Lee et al. BMI disutility applied	155	609

Abbreviations. BMI, body mass index; CI, confidence interval; EUR, 2018 euros; HbA1c, glycated hemoglobin; ICER, incremental cost-effectiveness analysis; QALY, quality-adjusted life year; UKPDS, United Kingdom Prospective Diabetes Study.

Figure 2. Cost-effectiveness acceptability curves from the probabilistic sensitivity analysis. Abbreviations. EUR, 2018 euros; QALY, quality-adjusted life year.

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