Semaglutide is a novel GLP-1R agonist with prolonged half-life due to enhanced binding to albumin and inhibition of degradation by dipeptidyl peptidase-4. SUSTAIN 7, an open-label, parallel-group, phase 3b trial of 1,201 individuals with type 2 diabetes inadequately controlled on metformin monotherapy compared semaglutide to dulaglutide over 40 weeks. Semaglutide 1.0 mg demonstrated statistical superiority to dulaglutide 1.5 mg in HbA1c lowering (-1.8% vs. -1.4% [ETD -0.41%; 95% CI -0.57 to -0.25]) and reductions in body weight (-6.5 kg vs. -3.0 kg [ETD -3.55 kg; -4.32 to -2.78]).
We used a validated non-product specific cost-effectiveness cohort model (the IHE Cohort Model of Type 2 Diabetes) to extrapolate outcomes and costs associated with semaglutide 1.0 mg vs. dulaglutide 1.5 mg over a 40-year time horizon. Treatment effects (e.g., HbA1c, BMI, and systolic blood pressure) as well as cohort characteristics were sourced from SUSTAIN 7. Treatment with semaglutide 1.0 mg and dulaglutide 1.5 mg were assumed to continue for three years, after which the cohort discontinued the initial treatments, and started insulin therapy. Costs and health-related quality of life impact associated with developing macro- and microvascular complications were sourced from a Canadian perspective where possible.
In the base case, semaglutide 1.0 mg was associated with fewer micro- and macrovascular complications (driven by observed differences in risk factors). For example, for every 1,000 individuals, four fewer patients in the semaglutide 1.0 mg arm were simulated to experience a stroke. Fewer events led to an increase in quality-adjusted life years of 0.05 at lower total costs for patients in the semaglutide 1.0 mg arm compared to the dulaglutide 1.5 mg arm. Results were tested in sensitivity analyses and found to be robust, suggesting that semaglutide 1.0 mg provides better health outcomes at a lower cost, compared to dulaglutide 1.5 mg.
P. Johansen: Consultant; Self; Janssen Global Services, LLC.. Employee; Self; Novo Nordisk A/S. J. Håkan-Bloch: Employee; Self; Novo Nordisk A/S. Employee; Spouse/Partner; Novo Nordisk A/S. A.R. Liu: None. S. Persson: None. E. Toresson Grip: None.