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The Cost-Effectiveness of Oral Semaglutide in Spain: A Long-Term Health Economic Analysis Based on the PIONEER Clinical Trials

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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.

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Acknowledgements

Funding

The study and the Rapid Service Fee was supported by funding from Novo Nordisk A/S, which provided consulting fees to Ossian Health Economics and Communications, Basel, Switzerland.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

The study was conceived and designed by all authors and conducted by Samuel Malkin. Samuel Malkin drafted the manuscript, which was reviewed, revised and approved by all authors.

Disclosures

Josep Vidal has the following financial relationships: advisor on scientific boards for Novo Nordisk and lectures for Eli Lilly and Company, Merck Sharp & Dohme and Novo Nordisk. Samuel Malkin and Barnaby Hunt are employees of Ossian Health Economics and Communications GmbH. Ossian received consulting fees from Novo Nordisk A/S to support preparation of the analysis. Virginia Martín and María Gallego Estébanez are employees of Novo Nordisk Pharma SA. Josep Franch-Nadal has received advisory and or speaking fees from AstraZeneca, Ascensia, Boehringer Ingelheim, GSK, Lilly, MSD, Novartis, Novo Nordisk, and Sanofi; he has received research grants to the institution from AstraZeneca, GSK, Lilly, MSD, Novartis, Sanofi, Boehringer Ingelheim and Novo Nordisk.

Compliance with Ethics Guidelines

This article is based on previously conducted clinical trials and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain

    Josep Franch-Nadal & Josep Vidal

  2. Primary Health Care Center Raval Sud, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de La Salut, Barcelona, Spain

    Josep Franch-Nadal

  3. Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland

    Samuel J. P. Malkin & Barnaby Hunt

  4. Novo Nordisk Pharma SA, Madrid, Spain

    Virginia Martín & María Gallego Estébanez

  5. Endocrinology and Nutrition Department, Hospital Clínic, Barcelona, Spain

    Josep Vidal

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  1. Josep Franch-Nadal
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  2. Samuel J. P. Malkin
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  5. María Gallego Estébanez
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Corresponding author

Correspondence to Samuel J. P. Malkin.

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Franch-Nadal, J., Malkin, S.J.P., Hunt, B. et al. The Cost-Effectiveness of Oral Semaglutide in Spain: A Long-Term Health Economic Analysis Based on the PIONEER Clinical Trials. Adv Ther 39, 3180–3198 (2022). https://doi.org/10.1007/s12325-022-02156-8

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  • DOI: https://doi.org/10.1007/s12325-022-02156-8

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