Page 34 - GHES-3-3

Global Health Economics and
Sustainability
Semaglutide for treating T2D and obesity

antidiabetic therapies has been linked to reduced mortality situation is further exacerbated by a significant shortage of
risk, particularly in elderly T2D patients (Rea et al., 2023). semaglutide, partly driven by its increased use for weight
The adherence outcomes are summarized in Table 3. loss, with a portion of the supply being redirected to the
wealthier populations, leaving disadvantaged groups,
9. Discussion especially those with T2D, with limited access to this

In socioeconomically disadvantaged areas, access to treatment. The availability of low-cost medications is
incretin therapies is often limited, despite the higher crucial from a societal perspective, highlighting the need
burden of T2D in these populations. This disparity is due for urgent implementation of a tiered reimbursement
to several factors, including limited healthcare access, model based on drug cost. This is critical, as the high
inadequate health coverage, and financial constraints. cost of treatment is one of the primary reasons for non-
As a result, treatment with SGLT-2i and GLP-1RA is less adherence, even among insured populations (Karagiannis
likely to be administered, while treatment with DPP-4i et al., 2023). The T2D treatment guidelines advocate for a
is more common due to their relatively lower cost. The patient-centered approach that takes into account patients’

Table 3. Comparative adherence outcomes
Study’s characteristics Adherence
Patients with ≥22 GLP-1RA prescription claims-mean PDC 12 months: 74.7%
(Weiss et al., 2020) 24 months: 71.8%
GLP-1RA PDC ≥80% 1-year on GLP-1RA therapy: 50.9%.
(Weiss et al., 2020)
GLP-1RA PDC ≥80% (by gender) 12 months: Females (48.4%); males (54.2%) adherent.
(Weiss et al., 2020) 24 months: Females (44.6%); males (51.1%)
GLP-1RA prevalence of adherence (PDC ≥80%) by age 12 months: <65 years (49.7%), 65 – 74 years (54.7%), >75 years (56.4%)
(Weiss et al., 2020) 24 months: <65 years (45.8%), 65 – 74 years (52.2%), ≥75 years (56.4%)
Cumulative adherence (PDC ≥80%) by dosage 24 months: decreased to 40.8% (daily doses) and to 59.8% (weekly doses)
(Weiss et al., 2020)
GLP-1RA use 360 days: Semaglutide QW (39.1%) > liraglutide (30.0%) > exenatide QW (27.7%)
(Uzoigwe et al., 2021) 360 days: Dulaglutide (43.2%)=semaglutide QW (39.1%)
DPP-4i use 12 months: 56.9%
(Ogundipe et al., 2021) 24 months: 44.2%
DPP-4i use 12 months: 36.0% non-adherent
(Ofori-Asenso et al., 2019)
SGLT-2i use: 22 studies/8 countries (Ofori‐Asenso et al., PDC at 6 months and 12 months: 0.77 and 0.72, respectively
2021) 6 months: 59.5% adherence
12 months: 49.0% adherence
Adherence varies across usage of different SGLT2i
SGLT-2i use 12 months: average PDC=0.64 – 0.79
(Lee & Lee, 2022). 12-month adherence: 44.3 – 72.1%
Canagliflozin >dapagliflozin
Empagliflozin >dapagliflozin
Sitagliptin=saxagliptin
Sitagliptin >linagliptin
GLP-1RA use 6months: average PDC=0.61 – 0.76
(Lee & Lee, 2022). Dulaglutide >albiglutide (OR 0.63)
Dulaglutide >exenatide BID (OR 0.32)
Dulaglutide >liraglutide (OR 0.65)
GLP-1RA use 6-month adherence: 38 – 54%
(Durden et al., 2019) 18 months: PDC ≥80%: GLP-1RA early responders* (0.66) > non-responders (0.62)
Notes: > and < denote statistically significant differences, whereas=denotes non-significant differences; *in this study, early response to GLP-1RA
therapy was defined as HbA1c reduction > 1% and reduction in body weight > 3% within 3 – 6 months after treatment initiation; Only patients with
≥ GLP-1 RA prescription claims were included in this study.
Abbreviations: BID: Twice daily; DPP-4i: Dipeptidyl peptidase-4 inhibitors; GLP-1RA: Glucagon-like peptide-1 receptor agonists; OR: Odds ratio;
PDC: Proportion of days covered; QW: Once weekly; SGLT-2i: Sodium-glucose cotransporter 2 inhibitors; T2D: Type 2 diabetes.

Volume 3 Issue 3 (2025) 26 https://doi.org/10.36922/ghes.8547