The cost-effectiveness of subcutaneous semaglutide 2.4 mg in the management of people living with obesity and prediabetes in England.

BACKGROUND: Prediabetes and type 2 diabetes (T2D) are more prevalent amongst people living with obesity (PwO). T2D and obesity increase the risk of cardiovascular disease. In the STEP clinical development program, once-weekly subcutaneous semaglutide (2.4 mg) reduced body weight by 10-15% and reversed prediabetes in about 80% of patients. The aim of this study was to assess the cost-effectiveness of semaglutide plus diet and exercise (D&E) compared with D&E alone in PwO and prediabetes in England based on the STEP-10 trial. METHODS: The published Core Obesity Model was populated with baseline characteristics and treatment efficacy from STEP-10. This study assessed the reversal of prediabetes at 52 weeks. Baseline age and body mass index (BMI) were 53 (SD = 11) years and 40.1 (6.9) kg/m. At 52 weeks, semaglutide plus D&E and D&E alone reversed prediabetes in 80% and 12% of patients, and decreased BMI by 13.9% and 2.7%, respectively. The perspective of the NHS was considered using annual discounting rates of 3.5% on costs and outcomes. Several subgroups were assessed: Different baseline BMI, number of comorbidities, proportions of prediabetes and different treatment durations. Individuals losing ≥ 5% of body weight after 20 weeks (responders) were analysed separately. RESULTS: The treatment duration in the base case analysis was 20 years. The use of semaglutide resulted in 1.105 QALY gained at an additional cost of 19,391 GBP. The resulting ICER was 17,547 GBP/QALY gained. Treatment with semaglutide extended life expectancy by 1.68 years. Ranging treatment duration between 1 year as per STEP 10 trial and lifelong resulted in an ICER of 7,152 to 17,695 GBP/QALY. Results did not differ significantly by subgroup. The probabilistic sensitivity analysis indicated a 90% chance of semaglutide being cost-effective at a willingness-to-pay threshold of 20,000 GBP/QALY. CONCLUSION: Semaglutide is a cost-effective treatment option for PwO and prediabetes in England based on the results of the STEP-10 trial.