Page 117 - GHES-2-4

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

associated with a low risk of hypoglycemia, their efficacy adverse events, so the contribution of such costs to the
in promoting weight loss varies. Therefore, considering overall analysis would likely be minor.
multiple composite outcomes that include glycemic Furthermore, this study does not encompass adherence
control, hypoglycemia, and weight loss is highly relevant data or HRQoL data. Previous studies have demonstrated
and essential when comparing antidiabetic treatments. that Type 2 diabetes patients often prefer oral treatments

The findings of this study align with previously published due to the burden of frequent injections (Boye et al., 2011;
short-term cost-effectiveness studies examining oral Ridderstrale et al., 2016). The fear of injectable treatments
semaglutide and liraglutide. Specifically, oral semaglutide is a significant factor contributing to therapeutic inertia
has been reported to have a lower cost of control for all (Fu & Sheehan, 2016; Khunti et al., 2018; Pantalone
examined treatment goals compared to liraglutide 1.8 mg et al., 2018). From this perspective, oral semaglutide might
in the USA (Hunt et al., 2021; Hansen et al., 2020). offer clinical and non-clinical benefits that are not fully
Although these findings cannot be directly compared captured in the present analysis. However, given that both
due to differences in the list prices of medicinal products sitagliptin and empagliflozin are also orally administered,
across various regions, oral semaglutide consistently incorporating adherence data would not likely change the
demonstrates a lower cost of control than liraglutide. main findings and conclusions of this study dramatically.
However, this study contradicts previous research A limitation of this study is that it considers only
that indicated a lower cost of control for oral semaglutide list prices without incorporating confidential paybacks
compared to sitagliptin (Hunt et al., 2021). Specifically, due in the form of voluntary discounts or volume-based
to the substantial difference in annual treatment costs – oral rebates. Given that such data are not readily available,
semaglutide had a 364% higher annual cost than sitagliptin using the pharmacy selling price and subtracting the
– it was not cost-effective compared to sitagliptin at a WTP patients’ contributions is the most reliable approach for
of EUR 1,000. Nevertheless, at the same WTP level, oral determining the medication costs borne by the third-
semaglutide was cost-effective compared to empagliflozin party payer in Greece. Moreover, the third-party payer in
for all examined treatment targets in over 75% of the PSA Greece has not published a WTP threshold for achieving
iterations. This is primarily due to the smaller difference in treatment targets over 52 weeks. While cost-effectiveness
annual treatment costs between the two medications, with acceptability curves can help examine the likelihood
oral semaglutide having a 129% higher annual cost than of new therapies being cost-effective at various WTP
empagliflozin. levels, the absence of published guidance on WTP for
This study has several limitations. First, it examines these treatment targets presents a significant challenge
treatment target outcomes using a binary classification in demonstrating value for money. This implies that the
(patients achieving and not achieving targets), which third-party payer in Greece may be reluctant to spend
excludes HbA1c and bone mass index reductions that EUR 1,000 for a patient to achieve a treatment target
patients might have experienced despite not achieving with oral semaglutide over 52 weeks compared to other
the examined thresholds. This means that health treatments. Such reluctance is often linked to budget
improvements that did not achieve specific targets were impact concerns that third-party payers consider when
not captured due to the reporting methods of clinical making reimbursement decisions. Even if an antidiabetic
efficacy used in the PIONEER trials. In addition, product is deemed cost-effective, it might still pose an
this study did not consider safety data, including “unaffordable” budget impact burden.
gastrointestinal issues, which are the most commonly, Importantly, this analysis does not include incremental
reported adverse events associated with GLP-1 receptor cost-effectiveness ratios, quality-adjusted life years,
agonists. For example, a composite treatment target averted disability-adjusted life years, or cost savings from
that includes achieving glycemic and weight loss targets reduced diabetes-related complications. A long-term
without gastrointestinal adverse events could provide cost-effectiveness analysis is essential to fully substantiate
valuable information regarding the benefit-risk profile the value of oral semaglutide compared to various
of the examined products. Incorporating such data into comparators. Nonetheless, a short-term cost-effectiveness
the analysis could also allow for the calculation of total analysis offers a preliminary comparative measure of value
costs (including drug acquisition and adverse events) per for money for payers. In addition, the results are based on
patient needed to achieve various treatment targets from a single randomized clinical trial; therefore, more data,
the third-party payer perspective. However, it is essential especially real-world evidence, is needed to confirm and
to note that PIONEER 2, 3, and 4 reported no statistically complement the trial findings with information on adverse
significant differences in the risk of Grade 3 and above events, quality of life, and adherence.

Volume 2 Issue 4 (2024) 10 https://doi.org/10.36922/ghes.3032