Abstract

Background & Aim: Semaglutide has shown significant clinical efficacy in managing type 2 diabetes (T2D); however, its cost-effectiveness remains uncertain. This study aims to systematically review existing evidence on cost-effectiveness of Semaglutide versus other T2D medications.

Methods: PubMed, Embase, and the Cost Effectiveness Analysis Registry were searched for studies on cost-effectiveness of Semaglutide versus other T2D medications. Two reviewers independently screened literature, extracted data, and assessed study quality. Study characteristics and model characteristics/inputs/results were extracted. Lifetime costs and QALYs were evaluated. Proportion of cost-effectiveness outcomes (dominant, cost-effective, not cost-effective) were calculated. Subgroup analyses were performed based on the region, sponsor type, perspective, time horizon, discount rate, and comparator type. Sensitivity analysis applied a standard WTP threshold of US$50,000.

Results: N=45 articles (with 119 comparisons) from 2019 onwards were included, representing Europe (n=24), North America (n=13), and Asia (all from China, n=8). Of these, 93.3% adopted a lifetime horizon, 84.5% employed a healthcare perspective, and 68.9% were industry-sponsored. Most studies demonstrated high reporting quality (86.7%). Overall, Semaglutide was dominant/cost-effective in 73.95% of all comparisons. Notably, Semaglutide was dominant/cost-effective in all comparisons sponsored by Novo Nordisk, versus 50% in these funded by non-industry sponsors and none funded by other industry sponsors. Additionally, Semaglutide was more cost-effective in high-income countries, and in studies adopting broader perspective, longer horizon, and lower discount rates, except when compared to Tirzepatide. Cost-effectiveness outcomes remained consistent when converted to a common currency unit and WTP threshold. However, findings were sensitive to HbA1c reduction, time horizon and discount rates, and cost of Semaglutide.

Conclusions: Semaglutide is generally cost-effective compared to other anti-diabetic medications when evaluated against within-study WTP thresholds; however, results varied by sponsor type, region, and model assumptions. The findings highlight the need for region-specific, context-sensitive analyses, along with transparent and unbiased reporting, to inform evidence-based healthcare decision-making.