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Once-Weekly Semaglutide for Patients with Type 2 Diabetes

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Emerging Technologies, Pharmacology and Therapeutics BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2019-000705 on 1 October 2019. Downloaded from Open access Original research Once- weekly semaglutide for patients with type 2 diabetes: a cost- effectiveness analysis in the Netherlands Barnaby Hunt ,1 Samuel J P Malkin,1 Robert G J Moes,2 Eline L Huisman,2 Tom Vandebrouck,3 Bruce H R Wolffenbuttel4 To cite: Hunt B, Malkin SJP, ABSTRACT Moes RGJ, et al. Once- weekly Objective Choosing therapies for type 2 diabetes Significance of this study semaglutide for patients that are both effective and cost- effective is vital as with type 2 diabetes: a healthcare systems worldwide aim to maximize health What is already known about this subject? cost- effectiveness analysis of the population. The present analysis assessed the ► Choosing therapies for type 2 diabetes that are both in the Netherlands. BMJ effective and cost- effective is vital as healthcare Open Diab Res Care cost- effectiveness of once- weekly semaglutide (a novel glucagon- like peptide-1 (GLP-1) receptor agonist) versus systems worldwide aim to maximize health of the 2019;7:e000705. doi:10.1136/ population, and the WHO recommends the use of bmjdrc-2019-000705 insulin glargine U100 (the most commonly used basal insulin) and versus dulaglutide (an alternative once- weekly cost- effectiveness analysis to ensure that interven- GLP-1 receptor agonist), from a societal perspective in the tions funded by a healthcare system represent good ► Additional material is Netherlands. value for money. The cost- effectiveness of once- published online only. To view Research design and methods The IQVIA CORE Diabetes weekly semaglutide, a novel glucagon- like peptide-1 please visit the journal online Model was used to project outcomes for once- weekly receptor agonist, has been assessed in a number of (http:// dx. doi. org/ 10. 1136/ semaglutide 0.5 mg and 1 mg versus insulin glargine countries, but numerous factors may influence the bmjdrc- 2019- 000705). U100, once- weekly semaglutide 0.5 mg versus dulaglutide cost- effectiveness of interventions in different set- 0.75 mg, and once- weekly semaglutide 1 mg versus tings. The aim of the present analysis was to assess Received 7 June 2019 dulaglutide 1.5 mg. Clinical data were taken from the the cost- effectiveness of once- weekly semaglutide Revised 29 August 2019 SUSTAIN 4 and SUSTAIN 7 clinical trials. The analysis from a societal perspective in the Netherlands. Accepted 11 September 2019 captured direct and indirect costs, mortality, and the What are the new findings? impact of diabetes- related complications on quality of life. Projections of outcomes over patient lifetimes sug- Results Projections of outcomes suggested that once- ► gest that once- weekly semaglutide 0.5 mg and 1 mg weekly semaglutide 0.5 mg was associated with improved are likely to improve clinical outcomes for patients quality- adjusted life expectancy by 0.19 quality- adjusted with type 2 diabetes compared with insulin glargine life years (QALYs) versus insulin glargine U100 and 0.07 QALYs versus dulaglutide 0.75 mg. Once- weekly U100 and dulaglutide. Compared with insulin http://drc.bmj.com/ semaglutide 1 mg was associated with mean increases glargine U100, improvements in clinical outcomes in quality- adjusted life expectancy of 0.27 QALYs versus came at an increased cost, but once- weekly sema- insulin glargine U100 and 0.13 QALYs versus dulaglutide glutide was considered cost-effective, even at the 1.5 mg. Improvements came at an increased cost versus lowest willingness- to- pay threshold identified in the insulin glargine U100, with incremental cost- effectiveness Netherlands. Improvements came at a reduced cost © Author(s) (or their ratios from a societal perspective of €4988 and €495 from a societal perspective versus dulaglutide, and employer(s)) 2019. Re- use per QALY gained for once- weekly semaglutide 0.5 mg and therefore once- weekly semaglutide was considered on September 24, 2021 by guest. Protected copyright. permitted under CC BY- NC. No 1 mg, respectively, falling below Netherlands- specific dominant. commercial re- use. See rights willingness- to- pay thresholds. Improvements versus and permissions. Published How might these results change the focus of dulaglutide came at a reduced cost from a societal by BMJ. research or clinical practice? perspective for both doses of once- weekly semaglutide. 1Ossian Health Economics Use of once- weekly semaglutide for treatment of Conclusions Once- weekly semaglutide is cost- effective ► and Communications, Basel, patients with type 2 diabetes is likely to be a good versus insulin glargine U100, and dominant versus Switzerland use of healthcare resources in the Netherlands. 2Novo Nordisk Farma, Alphen dulaglutide 0.75 and 1.5 mg for the treatment of type aan den Rijn, The Netherlands 2 diabetes, and represents a good use of healthcare 3SA Novo Nordisk Pharma, resources in the Netherlands. Brussels, Belgium constraints. Finite resources allocated to 4University of Groningen, healthcare are coming under increasing University Medical Center INTRODUCTION pressure due to both growing demand and Groningen, Groningen, The Choosing therapies to treat people with limited budget increases. The WHO recom- Netherlands type 2 diabetes that are both effective and mends the use of cost-effectiveness analysis to Correspondence to cost- effective is vital as healthcare systems ensure that funded interventions represent 1 Barnaby Hunt; worldwide aim to maximize health of the good value for money. This is particularly hunt@ ossianconsulting. com population while operating under resource pertinent when considering type 2 diabetes, BMJ Open Diab Res Care 2019;7:e000705. doi:10.1136/bmjdrc-2019-000705 1 BMJ Open Diab Res Care: first published as 10.1136/bmjdrc-2019-000705 on 1 October 2019. Downloaded from Emerging Technologies, Pharmacology and Therapeutics where the number of people with diabetes worldwide METHODS is expected to increase from 424.9 million in 2017 to Approach 628.6 million in 2045, with total healthcare expenditure A cost-effectiveness analysis was performed by projecting due to diabetes expected to rise from US$850 billion to costs and clinical outcomes over patient lifetimes US$958 billion over the same period.2 Diabetes- related following initiation of treatment with once-weekly sema- complications have a significant impact on the health glutide, daily insulin glargine U100, or dulaglutide. This status of people with diabetes, and are associated with approach aims to capture all complications, and there- significant costs, with annual costs increasing 1.7-fold, fore their impact on costs, life expectancy, and quality 2- fold and 3.5-fold in people with microvascular, macro- of life, as is recommended in guidelines on assessing the 13 vascular, and both microvascular and macrovascular cost-effectiveness of interventions for diabetes. The complications, respectively, compared with people with analysis was performed using the IQVIA CORE Diabetes diabetes with no complications.3 Therefore, reducing Model, a non-product- specific computer simulation the frequency of diabetes-related complications by model of diabetes, the capabilities and features of which 14 controlling risk factors, including glycemia, blood have been published previously. Long- term outcomes pressure, and body weight, is key for effective and cost- projected by the model were validated against long- term effective therapies.4–7 clinical data on first publication of the model in 2004 and 15 16 Glucagon- like peptide-1 (GLP-1) receptor agonists are following a series of model updates in 2014. a modern therapy for type 2 diabetes with multifactorial Modeled outcomes included direct medical costs, indi- benefits, reducing glycated hemoglobin (HbA1c) and rect costs, life expectancy (measured in years), quality- body weight with a low risk of hypoglycemia.8 The most adjusted life expectancy (measured in quality-adjusted recent consensus statement released by the European life years (QALYs)), and the cumulative incidence and Association for the Study of Diabetes and the American time to onset of diabetes-related complications. In cases Diabetes Association states that GLP-1 receptor agonists where an intervention is associated with increased costs should be considered for people with type 2 diabetes not and greater clinical benefits, costs and effectiveness are achieving glycemic control targets on metformin, particu- combined to give an incremental cost-effectiveness ratio larly those with established cardiovascular disease (where (ICER), describing the incremental cost per unit of effectiveness gained for the tested intervention versus evidence for a cardioprotective effect is strongest with the comparator, allowing assessment of whether an inter- liraglutide and semaglutide), with a compelling need vention represents good value for money. In scenarios to minimize hypoglycemia, or with a compelling need where an intervention is associated with reduced costs to minimize weight gain or promote weight loss.9 In the and increased clinical benefits, it is considered dominant Netherlands, GLP-1 receptor agonists are recommended versus the comparator and no calculation of an ICER for patients with a body mass index (BMI) ≥35 kg/m2 is required. The modeling analysis took into account whose blood glucose values cannot be adequately regu- mortality following diabetes-related complications, and lated with the combination of metformin and a
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