Page 109 - GHES-2-4

Global Health Economics and
Sustainability
Cost-effectiveness of oral semaglutide in Greece

manifests in adulthood, its prevalence among younger with insulin, to achieve glycemic control (Davies et al.,
populations has risen significantly in recent years, placing 2018; Buse et al., 2020).
a substantial burden on health systems globally. Diabetes is The American Diabetes Association (ADA) and the
particularly prevalent in Greece, with a reported prevalence European Association for the Study of Diabetes (EASD)
of 11.9% (Makrilakis et al., 2021), which is higher than the highlight the importance of managing cardiovascular risk in
average prevalence among adults in Europe (IDF, 2021). diabetic patients as early as possible, recommending the use
According to data from the Greek e-prescription system, of medications that reduce this risk. The ADA Standards of
there were 1.17 million diabetes patients in Greece in 2022, Care (2022) specifically recommend GLP-1 receptor agonists
with 91.84% of these cases being Type 2 diabetes.
or sodium-glucose cotransporter-2 (SGLT-2) inhibitors for
If not controlled in its early stages, Type 2 diabetes can diabetic patients with established cardiovascular disease.
lead to numerous complications, including macrovascular In April 2020, the European Medicines Agency (EMA)
and microvascular issues. Cardiovascular diseases are the granted marketing authorization for the first GLP-1 analog
most common diabetes-related complications, severely
affecting approximately 32% of patients (Einarson et al., that is orally administered daily. According to the EMA,
oral semaglutide is indicated for the treatment of Type 2
2018). These complications are the primary causes of death diabetes patients who are inadequately controlled, either
among patients with Type 2 diabetes, with cardiovascular as monotherapy when metformin is not appropriate or
diseases responsible for half of these deaths (Morrish in combination with other medications. The efficacy and
et al., 2001). Patients with Type 2 diabetes are more likely
to succumb to cardiovascular diseases than those without safety of oral semaglutide were evaluated in the PIONEER
Type 2 diabetes (Huxley et al., 2006). Unsurprisingly, clinical trial program, specifically in PIONEER 2, 3, and
diabetes-related complications negatively impact patients’ 4, which were 52-week, double-blind, double-dummy,
active- and placebo-controlled, parallel-group, multicenter,
health-related quality of life (HRQoL), with uncontrolled
patients experiencing significant deteriorations in their multinational trials. These trials compared oral semaglutide
quality of life compared to those who are well-managed 14 mg with empagliflozin 25 mg, sitagliptin 100 mg, and
(Rubin & Peyrot, 1999; UKPDS, 1999). liraglutide 1.8 mg (Pratley et al., 2019; Rodbard et al., 2019;
Rosenstock et al., 2019). The treatment policy estimand
Diabetes imposes a substantial financial burden on was used to consider clinical efficacies for all patients,
health systems and societies, with the IDF estimating regardless of treatment discontinuation. The PIONEER trials
that approximately USD 850 billion was spent globally on examined a range of single and composite outcomes over
treating diabetes and its related complications in 2017. This 52 weeks, providing a clinically meaningful assessment of the
figure is predicted to exceed USD 1 trillion by 2030 (IDF, effectiveness of these different treatments (Pratley et al., 2019).
2021). The majority of diabetes-related costs are attributed
to complications, which can be avoided through access to The present analysis investigated the cost per patient
innovative treatments that ensure effective disease control. of achieving seven treatment goals with oral semaglutide
A report by Kanavos et al. (2012) showed that in the EU5, 14 mg versus empagliflozin 25 mg, sitagliptin 100 mg, and
the cost of pharmacotherapies used to treat diabetes- liraglutide 1.8 mg from the perspective of the Greek third-
related complications was 3 times higher than the drug party payer (EOPYY). The treatment targets examined were:
acquisition costs for treating diabetes. (i) HbA1c ≤6.5%, (ii) HbA1c <7%, (iii) ≥1%-point HbA1c
reduction, (iv) HbA1c <7% without hypoglycemia and no
The primary aim of diabetes therapy is to prevent weight gain, (v) weight loss ≥5%, (vi) weight loss ≥10%, and
the manifestation of diabetes-related complications (vii) ≥1%-point HbA1c reduction and weight loss ≥3%.
and to improve patients’ HRQoL, which requires
adequate glycemic control (Hemoglobin A1C [HbA1c] 2. Data and methods
<7%). Current therapeutic options for Type 2 diabetes 2.1. Clinical effectiveness
include biguanides, sulfonylureas, thiazolidinediones,
dipeptidyl peptidase-4 inhibitors, sodium-glucose Clinical effectiveness data on the percentage of patients
co-transporter-2 inhibitors, meglitinides, glucagon- achieving the seven examined treatment targets were
like peptide-1 (GLP-1) receptor agonists, and insulin. retrieved from the PIONEER 2, 3, and 4 clinical trials, where
Metformin, along with lifestyle modifications, is the oral semaglutide 14 mg was compared with empagliflozin
most commonly employed first-line treatment. However, 25 mg, sitagliptin 100 mg, and liraglutide 1.8 mg (Rodbard
due to the progressive and chronic nature of the disease, et al., 2019; Rosenstock et al., 2019; Pratley et al., 2019).
most patients require therapy intensification with the This study utilized data on the percentage of patients
coadministration of injectable or oral therapies, along achieving treatment goals at 52 weeks (Table 1).

Volume 2 Issue 4 (2024) 2 https://doi.org/10.36922/ghes.3032