Wegovy likely not cost-effective in the SELECT trial population
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Key takeaways:
- Semaglutide 2.4 mg may not be cost-effective for secondary CVD prevention for those with overweight/obesity without diabetes.
- The price would need to be halved, based on the estimated cost in Australia.
Researchers estimate that semaglutide 2.4 mg is not cost-effective for secondary CVD prevention for patients with overweight or obesity without diabetes, according to an Australian study.
Ella Zomer, BBiomedSc, PhD, senior 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 at least halved before it becomes cost-effective in their current health care system.
“Weight management has not traditionally been considered a therapeutic target for improving cardiovascular outcomes. Part of this relates to the complex, multifactorial (environmental, genetic and physiological) nature of obesity that means it is difficult to treat, often resulting in relapse and weight regain,” the researchers wrote. “Dedicated studies in patients with overweight or obesity have demonstrated higher doses of the GLP-1 receptor agonist semaglutide are capable of inducing durable 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 medication has raised concerns about its accessibility within health care systems for managing cardiovascular risk. In Australia, the cost of semaglutide 2.4 mg weekly is likely to be [more than 300 Australian dollars] per month. Internationally, prices are even higher, fueled by a combination of limited supply and robust demand,” they wrote.
The SELECT trial
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 CVD events for patients with overweight or obesity without diabetes in the Australian health care system. The data were published in European Heart Journal - Quality of Care and Clinical Outcomes. SELECT was a randomized controlled trial to evaluate once-weekly semaglutide vs. placebo for the reduction of secondary major adverse CV events among 17,604 adults with preexisting CVD and overweight or obesity without diabetes over nearly 40 months of follow-up.
As Healio previously reported, once-weekly semaglutide 2.4 mg was associated with significantly fewer secondary CVD events in this patient population.
For the present hypothetical analysis, Zomer and colleagues estimated the costs of semaglutide over 20 years based on the SELECT data, and all outcomes were discounted 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 was estimated to be AU$4,175.
With the commonly accepted willingness-to-pay threshold of $50,000 per QALY gained, the researchers stated semaglutide 2.4 mg for the secondary prevention of CVD events in the SELECT trial patient population is not cost-effective at its current price.
Zomer and colleagues estimated the actual ICER for 1 year of life saved was AU$99,853 — $143,504 in the U.S. or 40,873 British pounds— and $96,055 per QALY gained — $138,046 in the U.S or 39,318 British pounds.
Following threshold analyses, the researchers estimated that semaglutide 2.4 mg would not reach cost-effectiveness in the SELECT trial 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 evaluate the cost-effectiveness of semaglutide compared with placebo for the reduction in cardiovascular events in those with overweight or obesity and established CVD, but without diabetes,” the researchers wrote. “Our results indicate that the clinical benefits of reduced cardiovascular events and mortality in the semaglutide group are offset by the high cost of the drug. Thus, semaglutide is not cost-effective from the Australian health care perspective at current estimated prices.”
The researchers wrote that the currently stated ICER estimates do not account for indirect costs of secondary CVD events, such as lost productivity, nor did they consider the cost savings with discontinuation of BP medications or lipid-lowering therapies associated with treating obesity.
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