OBJECTIVES: To evaluate the cost-utility of semaglutide in comparison with dulaglutide, both once weekly, in patients with type 2 diabetes (T2D) requiring treatment intensification with a GLP-1 receptor agonist in South Korea.

METHODS: A cost-utility analysis was conducted from the perspective of the South Korea’s public healthcare system, according to the Health Insurance Review and Assessment Service guidelines. A 40 year time horizon and discounting of 4.5% were applied. The analysis was based on the Institute for Health Economics Diabetes Cohort Model. Clinical data were derived from the SUSTAIN 7, SUSTAIN-5 and AWARD-9 trials, and adverse event risk from UK Prospective Diabetes Study data. Cost items were identified by reviewing diabetes treatment guidelines, clinical trials, and published economic evaluations. Only direct healthcare costs were included, such as consultation fees, medication costs, and treatment costs for diabetes complications and adverse events. Costs were calculated using health-insurance-price-related data, statistical data, and related literature. The analysis was performed separately for patients whose diabetes was inadequately controlled, either on metformin and sulfonylurea (oral group), or on insulin, with or without metformin (insulin group).

RESULTS: In the oral drug group, once-weekly semaglutide resulted in incremental cost-effectiveness ratios of 25.017 million KRW and 24.994 million KRW for the low-dose (semaglutide 0.5 mg vs dulaglutide 0.75 mg) and high-dose (semaglutide 1 mg vs dulaglutide 1.5 mg) group, respectively. Treatment with once-weekly semaglutide was found to dominate dulaglutide when added to basal insulin.

CONCLUSIONS: Our results indicate that the introduction of once-weekly semaglutide as an alternative to dulaglutide is likely to be considered cost-effective for treatment intensification in patients insufficiently controlled on metformin plus sulfonylurea, at a commonly accepted threshold of 25 million KRW/QALY for non-severe diseases, and would lead to cost-savings and clinical benefits in those on basal insulin requiring treatment intensification.