Wegovy is unlikely to be cost-effective in the SELECT study population
29 August 2024
3 minutes reading time
Key findings:
- In overweight/obese individuals without diabetes, administration of 2.4 mg semaglutide for the secondary prevention of cardiovascular disease may not be cost-effective.
- The price would have to be halved based on estimated costs in Australia.
According to an Australian study, researchers assume that 2.4 mg of semaglutide is not cost-effective for the secondary prevention of cardiovascular disease in overweight or obese patients without diabetes.
Ella Summers, BBiomedSc, PhDsenior research fellow at Monash University School of Public Health and Preventive Medicine in Melbourne, Australia, and colleagues estimated that the cost of semaglutide 2.4 mg (Wegovy, Novo Nordisk) would need to be cut by at least half before it would be cost-effective in their current health care system.
“Weight control has not traditionally been considered a therapeutic target to improve cardiovascular outcomes. In part, this is due to the complex, multifactorial (environmental, genetic, and physiological) nature of obesity, which makes it difficult to treat and frequently leads to relapse and weight regain,” the researchers wrote. “Specific studies in patients with overweight or obesity have shown that higher doses of the GLP-1 receptor agonist semaglutide are able to induce sustained weight loss of approximately 10 to 15% in the presence or absence of diabetes, with an encouraging safety profile.
“Despite the clinical benefits of semaglutide, the high cost of the drug has raised concerns about its availability in health systems for the treatment of cardiovascular risks. In Australia, the cost of 2.4 mg of semaglutide per week is likely to be more than A$300 per month. Internationally, prices are even higher due to a combination of limited supply and strong demand,” they wrote.
The SELECT study
Zomer and colleagues developed a Markov model based on the SELECT trial to compare clinical outcomes and costs of semaglutide 2.4 mg with placebo for the hypothetical secondary prevention of cardiovascular events in patients with overweight or obesity without diabetes in the Australian health system. The data were published in European Heart Journal – Quality of care and clinical outcomesSELECT was a randomised controlled trial evaluating once-weekly semaglutide compared with placebo for reducing secondary major cardiovascular adverse events in 17,604 adults with pre-existing cardiovascular disease and overweight or obesity without diabetes over a period of almost 40 months.
As Healio previously reported, weekly administration of 2.4 mg of semaglutide was associated with significantly fewer secondary cardiovascular events in this patient group.
For the present hypothetical analysis, Zomer et al. estimated the costs of semaglutide over 20 years based on the SELECT data, and all results were discounted at 5% annually.
The main outcomes were the incremental cost-effectiveness ratio (ICER) in terms of cost per year of life saved and quality-adjusted life year gained.
Cost-effectiveness of semaglutide
The annual cost of semaglutide 2.4 mg in Australia is estimated at AU$4,175.
Given the generally accepted willingness to pay of $50,000 per QALY gained, the researchers concluded that semaglutide 2.4 mg is not cost-effective for the secondary prevention of cardiovascular events in the SELECT trial patient population at the current price.
Zomer and colleagues estimated the actual ICER for a year of life saved to be AU$99,853 – $143,504 in the US or £40,873 – and $96,055 per QALY gained – $138,046 in the US or £39,318.
Following threshold analyses, the researchers estimated that 2.4 mg semaglutide would not be cost-effective in the SELECT study population until the price was more than halved to AU$2,000 per year.
“To the best of our knowledge, this is the first study to examine the cost-effectiveness of semaglutide compared with placebo in reducing cardiovascular events in overweight or obese patients with documented cardiovascular disease but without diabetes,” the researchers wrote. “Our results demonstrate that the clinical benefits of reducing cardiovascular events and lower mortality in the semaglutide group are offset by the high cost of the drug. Therefore, from an Australian health care perspective, semaglutide is not cost-effective at current estimated prices.”
The researchers wrote that the currently presented ICER estimates do not take into account the indirect costs of secondary cardiovascular events, such as lost productivity, nor the cost savings from discontinuing blood pressure medications or lipid-lowering therapies associated with the treatment of obesity.
Sources/Disclosures
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Announcement: Zomer reports no relevant financial disclosures. The relevant financial disclosures of all other authors can be found in the study.
