Long- and Short-Term Cost-Effectiveness of Once-Weekly Semaglutide versus Dulaglutide for the Treatment of Type 2 Diabetes in China: A Hypothetical Modeling Exercise

Introduction: This study aimed to evaluate the long- and short-term cost-effectiveness of once-weekly semaglutide versus dulaglutide for treating patients with type 2 diabetes uncontrolled with metformin after the renewal of China's national reimbursement drug list. Methods: This analysis was conducted using the Institute of Health Economics Diabetes Cohort Model (IHE-DCM) to evaluate the long-term health and economic outcomes of semaglutide 0.5 mg, 1.0 mg, and dulaglutide 1.5 mg. It was performed from the perspective of the Chinese healthcare systems over a 40-year time horizon, with an annual discount rate of 5%. Baseline cohort characteristics and treatment effects were sourced from the head-to-head clinical trial SUSTAIN 7, which compared the efficacy and safety of semaglutide and dulaglutide. The analysis included direct medical costs regarding antidiabetic treatment and complication treatment. The long-term cost-effectiveness analysis used quality-adjusted life years (QALYs) as the primary health outcome. The robustness of the results was evaluated through one-way sensitivity analyses and probabilistic sensitivity analyses. The short-term cost-effectiveness analysis, focusing on the proportion of patients achieving clinical targets as the health outcome, compared the control costs of successfully treating a patient to meet clinical treatment goals between semaglutide 0.5 mg, 1.0 mg, and dulaglutide 1.5 mg over a 40-week study period. Results: Compared with dulaglutide 1.5 mg, once-weekly semaglutide 0.5 mg demonstrated an improvement of 0.08 QALYs and a reduction in total direct medical costs of 5476 Chinese yuan (CNY); Once-weekly semaglutide 1.0 mg showed an increase of 0.19 QALYs, and a decrease in total direct medical costs of 6711 CNY. Sensitivity analyses confirmed the robustness of these results. In the short-term cost-of-control study, once-weekly semaglutide 0.5 mg demonstrated lower treatment costs for all targets: the costs of control for dulaglutide 1.5 mg were 1.2-2.1 times as much as that of semaglutide 0.5 mg once weekly. Semaglutide 1.0 mg achieved similar treatment costs for the good glycemic control goal (HbA1c < 7%) to dulaglutide 1.5 mg. However, when looking at tight glycemic control, weight management targets, and composite targets relating to weight loss, once-weekly semaglutide 1.0 mg showed lower treatment costs compared to dulaglutide 1.5 mg to bring at least one patient to achieve these targets. Conclusions: Compared to dulaglutide 1.5 mg, once-weekly semaglutide remains cost-effective for treating type 2 diabetes uncontrolled on metformin in China under the new negotiation price. However, limitations exist, including the reliance on SUSTAIN-7 data and the lack of specific utility data for the Chinese population.