OBJECTIVES: SELECT is the only cardiovascular outcomes trial to demonstrate reductions in risk of major adverse cardiovascular (CV) events for a weight-management pharmacotherapy compared with placebo in people with overweight/obesity and CV disease without type 2 diabetes (T2D). Semaglutide 2.4mg represents a pivotal development in the clinical management of obesity and CV disease, but cost-effectiveness in this population remains unclear. We report a cohort-level Markov-state cost-effectiveness model (CEM) that uses SELECT data to assess the health-economic impacts of semaglutide 2.4mg beyond weight-loss.

METHODS: The CEM assesses quality-adjusted life-years (QALYs) and costs over a lifetime time-horizon for US people with body mass index (BMI) ≥27 kg/m² receiving once-weekly semaglutide (target dose 2.4mg) compared with placebo in addition to standard care. Baseline characteristics, treatment effects, adverse event rates, discontinuation and survival equations were aligned to SELECT trial data and extrapolated to a lifetime time-horizon (39 years). The observed 73% risk reduction in the development of T2D while on treatment from the SELECT trial was extrapolated over the modelled horizon. Treatment costs were sourced from US list prices; US healthcare costs from published sources and benefits were discounted at 3.0%. Cost-effectiveness was assessed against typical willingness-to-pay (WTP) thresholds described by the Institute for Clinical and Economic Review.

RESULTS: Per 100,000 people, semaglutide 2.4mg was predicted to avoid 2,464 (-9.52%) non-fatal myocardial infarctions, 2,100 (-7.71%) coronary revascularizations, 441 (-4.75%) non-fatal strokes and 505 (-2.88%) CV deaths over the modelled lifetime horizon. Mean semaglutide 2.4mg treatment duration was 2.95 years. Per patient, treatment costs were $47,679, offset by savings from avoided T2D ($8,835), chronic kidney disease ($746) and CV events ($1,793). Semaglutide 2.4mg treatment was associated with an increase in predicted lifetime costs ($36,142) and QALYs (0.257), yielding an incremental cost-effectiveness ratio of $140,512.

CONCLUSIONS: Semaglutide 2.4mg therapy was predicted to be cost-effective at a $150,000 WTP threshold.