OBJECTIVES

Management of type 2 diabetes aims to maintain glycemic control with a low risk hypoglycemic events and avoidance of weight gain. The present analysis assessed the long-term cost-effectiveness of once-weekly semaglutide 1 mg versus once-daily empagliflozin 25 mg for the treatment of patients with type 2 diabetes mellitus with inadequate glycemic control on metformin monotherapy from a healthcare payer perspective in Portugal.

METHODS

Long-term clinical and economic outcomes with once-weekly semaglutide 1 mg and once-daily empagliflozin 25 mg were projected using the IQVIA CORE Diabetes Model. Clinical inputs in terms of patient characteristics and the impact of treatments on risk factors were based on an indirect comparison conducted using patient-level data, as, to date, there is no head-to-head clinical trial comparing the two interventions. Both treatments were added to metformin and continued until glycated hemoglobin exceeded a threshold of 7.5%, at which point patients switched therapy to basal insulin. Pharmacy and complication costs, expressed in 2019 Euros (EUR), and utilities were applied. Future outcomes were discounted at 4% per annum.

RESULTS

Over patient lifetimes, once-weekly semaglutide 1 mg was associated with increased life expectancy (12.80 versus 12.70 years) and quality-adjusted life expectancy (7.18 versus 6.98 quality-adjusted life years [QALYs]) compared with once-daily empagliflozin 25 mg. The benefits resulted from a reduced incidence and delayed onset of diabetes-related complications. Cost savings resulting from avoided diabetes-related complications partially offset increased pharmacy costs with once-weekly semaglutide, leading to an overall cost increase of EUR 2,804 (EUR 24,845 versus EUR 22,041). Once-weekly semaglutide was associated with an incremental cost-effectiveness ratio of EUR 14,114 per QALY gained versus once-daily empagliflozin.

CONCLUSIONS

Compared with once-daily empagliflozin 25 mg, once-weekly semaglutide 1 mg was projected to be a cost-effective treatment from a healthcare payer perspective for patients with type 2 diabetes in Portugal.