The Cost-Effectiveness of Subcutaneous Semaglutide Versus Empagliflozin in Type 2 Diabetes Uncontrolled on Metformin Alone in Denmark

Abstract

Introduction: International and Danish guidelines recommend the use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 (SGLT-2) inhibitors already in second line in the management of type 2 diabetes (T2D). The objective of this study was to evaluate the long-term cost-effectiveness (CE) of subcutaneous (SC) semaglutide (GLP-1 RA) versus empagliflozin (SGLT-2 inhibitor) in individuals with T2D uncontrolled on metformin alone from a Danish payer's perspective.

Methods: Cost-effectiveness analyses (CEA) were conducted from a Danish payer's perspective, using the IQVIA Core Diabetes model (CDM 9.5), with a time horizon of 50 years and an annual discount of 4% on costs and effects. Patients received either SC semaglutide or empagliflozin, in addition to metformin, until HbA1c threshold of 7.5% (58 mmol/mol) was reached, following which treatment intensification with insulin glargine in addition to empagliflozin or SC semaglutide plus metformin was considered. Baseline cohort characteristics and treatment effects were sourced from a published CEA. Utilities and cost of diabetes-related complications were also obtained from published sources. Treatment costs were derived from Danish official sources. Scenario analyses were also performed to test the accuracy of the base case results.

Results: Individuals with T2D on SC semaglutide plus metformin gained 0.065 life-years (LYs) and 0.130 quality-adjusted LYs (QALYs), respectively, at an incremental cost of DKK 96,923 (€ 13,031) compared to empagliflozin plus metformin, resulting in an incremental cost-effectiveness ratio (ICER) of DKK 745,561(€ 100,239) per QALY gained. The probabilistic sensitivity analysis (PSA) results showed that the SC semaglutide plus metformin was cost-effective in 19% of simulations assuming a willingness-to-pay (WTP) threshold of DKK 357,100 (€ 48,011)/QALY gained. Duration of therapy with SC semaglutide seems the key driver of results.

Conclusion: The current analyses suggest that SC semaglutide plus metformin is not cost-effective compared to empagliflozin plus metformin from a Danish payer's perspective.

Keywords: Cost-effectiveness; Costs and cost analysis; Denmark; Empagliflozin; GLP-1 receptor agonist; IQVIA Core Diabetes Model; SC semaglutide; SGLT-2 inhibitors; Treatment intensification; Type 2 diabetes.

Fig. 1

Cost-effectiveness scatterplots and cost-effectiveness acceptability curves: a Cost-effectiveness scatterplot for SC semaglutide vs. empagliflozin of the base case analysis using 2L treatment arm. b Cost- effectiveness acceptability curve for SC semaglutide vs. empagliflozin of the base case analysis using 2L treatment arm. c Cost-effectiveness scatterplot for SC semaglutide vs. empagliflozin of the scenario analysis using 3L treatment arm. d Cost-effectiveness acceptability curve of the scenario analysis using 3L treatment arm. DKK, Danish krone; QALY, quality-adjusted life-years; WTP, willingness to pay