Page 116 - GHES-2-4

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

Figure 9. Cost-effectiveness acceptability curve of oral semaglutide 14 mg versus sitagliptin based on PIONEER 3. Figure created using Microsoft Excel

effectiveness results from the PIONEER 2, 3, and 4 trials provide crucial information regarding the quality-adjusted
over a 52-week period, the analysis revealed that while oral life years gained by new medications and the total costs
semaglutide is cost-effective compared to liraglutide, it may associated with achieving these outcomes. Such figures
not be as cost-effective as empagliflozin and sitagliptin in can be compared across different interventions by payers,
achieving the seven treatment targets at its current price. health technology assessment bodies, and budget holders
The treatment targets examined in this study align who seek to maximize value for money.
with modern clinical guidelines for diabetes treatment, This study represents the first cost-of-control analysis
which emphasize a comprehensive approach that includes based on the PIONEER 2, 3, and 4 trials, specifically
elements beyond glycemic control, such as HbA1c considering clinical effectiveness after 52 weeks of
reduction, to improve patients’ well-being (Kim et al., 2022; treatment. Previous short-term cost-effectiveness studies
Curry et al., 2018). A significant advantage of this study is conducted in the USA focused on the percentage of
its focus on treatment targets outlined in the most recent patients achieving treatment targets at 26 weeks. The
ADA and EASD clinical guidelines and recommendations, extended analysis period in this study offers a more reliable
ensuring that the analysis is both applicable and relevant assessment of the sustained efficacy and cost-effectiveness
in clinical practice. Another key strength of this study is of anti-diabetic medications, as the benefits of diabetes
the use of a straightforward and transparent methodology, treatments can change over time, potentially altering the
which facilitates easy assessment and replication by other long-term value of treatments that initially appear cost-
interested parties. The model provides clear clinical and effective (Hunt et al., 2021; Hansen et al., 2020). A 52-week
cost inputs that can be readily assessed and modified as timeframe aligns more closely with real-world practices, as
new clinical evidence becomes available. Specifically, the most patients with diabetes require lifelong treatment to
model allows for the consideration of voluntary discounts manage this complex, multifactorial condition. Therefore,
when examining the cost of control of medications. This exploring the cost-effectiveness of treatments over an
is particularly relevant for payers, as it enables them to extended period allows for more informed and relevant
calculate the discount applied to the ex-factory price of decision-making.
products to achieve an average cost of control below the The present study differentiates itself from previous
WTP threshold.
studies by examining the risk of hypoglycemia and weight
A crucial consideration in this study is the reliability of loss targets (5% and 10%) at 52 weeks. Previous studies
its results, given the short-term horizon. Traditional long- have focused almost exclusively on achieving HbA1c
term cost-effectiveness models rely on data reported in targets (Hunt et al., 2021; Hansen et al., 2020). However,
clinical trials and extrapolate outcomes using risk equations, focusing solely on glycemic control targets overlooks
which are inherently subject to increased uncertainty due current treatment guidelines that advocate for a patient-
to the complexity of Type 2 diabetes. This study aims to centric perspective, addressing risk factors such as
complement long-term cost-effectiveness analysis by hypoglycemia and body weight, which increase the risk of
exploring the cost-effectiveness of these interventions diabetes-related complications (Handelsman et al., 2015).
in natural units. Long-term cost-effectiveness analyses While most GLP-1 agonists and SGLT-2 inhibitors are

Volume 2 Issue 4 (2024) 9 https://doi.org/10.36922/ghes.3032