Cost-effectiveness analysis of Oral Semaglutide treatment for type 2 diabetes mellitus patients: a systematic review 10.55131/jphd/2024/220322

Main Article Content

I Kadek Suardiana
Dwi Endarti
Tuangrat Phodha

Abstract

GLP-1 is a new generation of antidiabetics recommended by the American Diabetes Association and European Association for the study of diabetes as an add-on therapy for metformin when therapeutic purposes are not achieved. In this context, oral Semaglutide received FDA approval in September 2019 to be used alongside dietary and exercise regimens to enhance glycemic management in adults diagnosed with type 2 diabetes mellitus (T2DM). Therefore, this systematic review aimed to analyze cost-effectiveness of oral Semaglutide compared to other antidiabetics and/or injectable GLP-1 within the same group. Three databases namely Scopus, ScienceDirect, and PubMed were used for the literature search. Preferred Reporting Items for Systematic Review (PRISMA) guidelines were used to select the studies based on the inclusion and exclusion criteria. Quality assessment was carried out using CHEERS 2022, while the decision on cost-effectiveness was determined using the willingness-to-pay thresholds stated in each study. The results showed that from the initial search yielding 240 studies, 12 met the inclusion criteria. Oral Semaglutide was considered cost-effective compared to SGLT2 and DPP4 inhibitors, as well as injectable GLP-1 due to its higher effectiveness and lower cost. However, it was not cost-effective compared to biguanide/conventional therapy due to the higher cost. The primary sources of uncertainty in the studies were identified as time horizon, discount rate, cost, and treatment policy estimand. In conclusion, the development of oral Semaglutide represents a significant advancement in antidiabetic medications. This systematic review showed that oral Semaglutide appeared to be more cost-effective compared to other antidiabetic medications for T2DM.

Article Details

How to Cite
1.
Suardiana IK, Endarti D, Phodha T. Cost-effectiveness analysis of Oral Semaglutide treatment for type 2 diabetes mellitus patients: a systematic review: 10.55131/jphd/2024/220322. J Public Hlth Dev [Internet]. 2024 Sep. 9 [cited 2024 Nov. 5];22(3):272-88. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/269739
Section
Review articles
Author Biographies

I Kadek Suardiana, Master Program of Pharmacy Management, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Master Program of Pharmacy Management, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Dwi Endarti, Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.

Tuangrat Phodha, Center of Excellence in Pharmacy Practice and Management Research Unit, Faculty of Pharmacy, Thammasat University, Rangsit Campus, Pathum Thani, Thailand.

Drug Information and Consumer Protection Center, Faculty of Pharmacy, Thammasat University, Rangsit Campus, Pathum Thani, Thailand.

Center of Excellence in Pharmacy Practice and Management Research Unit, Faculty of Pharmacy, Thammasat University, Rangsit Campus, Pathum Thani, Thailand.

References

International Diabetes Federation (IDF). Diabetes Fact Figures [Internet]. [Cited 2023 November 21]. Available from: https://idf.org/about-diabetes/ diabetes-facts-figures/

Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):14790. doi: 10.1038/ s41598-020-71908-9

Seuring T, Archangelidi O, Suhrcke M. The Economic Cost of Type 2 Diabetes: A Global Systematic Review. Pharmacoeconomics. 2015;33(8):811-31. doi: 10.1007/s40273-015-0268-9

Joshi SR, Rajput R, Chowdhury S, Singh AK, Bantwal G, Das AK, et al. The role of oral Semaglutide in managing type 2 diabetes in Indian clinical settings: Addressing the unmet needs. Diabetes Metab Syndr. 2022; 16(6):102508. doi: 10.1016/j.dsx. 2022.102508

Chubb B, Gupta P, Gupta J, Nuhoho S, Kallenbach K, Orme M. Once-Daily Oral Semaglutide Versus Injectable GLP-1 RAs in People with Type 2 Diabetes Inadequately Controlled on Basal Insulin: Systematic Review and Network Meta-analysis. Diabetes Ther. 2021;12(5):1325-1339. doi: 10.1007/ s13300-021-01034-w

Avgerinos I, Michailidis T, Liakos A, Karagiannis T, Matthews DR, Tsapas A, et al. Oral Semaglutide for type 2 diabetes: A systematic review and meta‐analysis. Diabetes Obes Metab. 2020;22(3):335-345. doi: 10.1111/ dom.13899

Malkin SJP, Carvalho D, Costa C, Conde V, Hunt B. The long-term cost-effectiveness of oral Semaglutide versus empagliflozin and dulaglutide in Portugal. Diabetol Metab Syndr. 2022;14(1):32. doi: 10.1186/s13098-022-00801-4

Malkin SJP, Hunt B, Huisman EL, Grand TS, Chubb B. The long-term cost-effectiveness of oral Semaglutide in the Netherlands based on the PIONEER 2, 3, and 4 randomized controlled trials. Diabetes Res Clin Pract. 2021;175:108759. doi: 10.1016/ j.diabres.2021.108759

Choi JG, Winn AN, Skandari MR, Franco MI, Staab EM, Jason A, et al. First-Line Therapy for Type 2 Diabetes With Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: A Cost-Effectiveness Study. Ann Intern Med. 2022;175(10):1392-1400. doi: 10.7326/ M21-2941

Ren H, Berry S, Malkin SJP, Hunt B, Bain S. Early use of oral Semaglutide in the UK: A cost-effectiveness analysis versus continuing metformin and SGLT-2 inhibitor therapy. BMJ Open. 2023;13(9):e070473. doi: 10.1136/ bmjopen-2022-070473

Pulleyblank R, Larsen NB. Cost-Effectiveness of Semaglutide vs. Empagliflozin, Canagliflozin, and Sitagliptin for Treatment of Patients with Type 2 Diabetes in Denmark: A Decision-Analytic Modelling Study. Pharmacoecon Open. 2023;7(4):579-591. doi: 10.1007/s41669-023-00416-z

Feng Z, Tong WK, Zhang X, Tang Z. Cost-effectiveness analysis of once-daily oral Semaglutide versus placebo and subcutaneous glucagon-like peptide-1 receptor agonists added to insulin in patients with type 2 diabetes in China. Front Pharmacol. 2023;14: 1226778. doi: 10.3389/fphar.2023. 1226778

Risebrough NA, Baker TM, Zhang L, Ali SN, Radin M, Dang-Tan T. Lifetime Cost-effectiveness of Oral Semaglutide Versus Dulaglutide and Liraglutide in Patients With Type 2 Diabetes Inadequately Controlled With Oral Antidiabetics. Clin Ther. 2021; 43(11):1812-1826. doi: 10.1016/ j.clinthera.2021.08.015

Bain SC, Hansen BB, Malkin SJP, Nuhono S, Valentine WJ, Chubb B, et al. Oral Semaglutide Versus Empagliflozin, Sitagliptin and Liraglutide in the UK: Long-Term Cost-Effectiveness Analyses Based on the PIONEER Clinical Trial Programme. Diabetes Ther. 2020; 11(1):259-277. doi: 10.1007/s13300-019-00736-6

Cui J, Klepser DG, McAdam-Marx C. Short-term cost-effectiveness of oral Semaglutide for the treatment of type 2 diabetes mellitus in the United States. J Manag Care Spec Pharm. 2021; 27(7):840-845. doi: 10.18553/jmcp. 2021.27.7.840

Ehlers LH, Lamotte M, Ramos MC, Sandgaard S, Holmgaard P, Frary EC, et al. The cost–effectiveness of oral Semaglutide versus empagliflozin in Type 2 diabetes in Denmark. J Comp Eff Res. 2022;11(1):29-37. doi: 10.2217/cer-2021-0169

Eliasson B, Ericsson Å, Fridhammar A, Nilsson A, Persson S, Chubb B. Long-Term Cost Effectiveness of Oral Semaglutide Versus Empagliflozin and Sitagliptin for the Treatment of Type 2 Diabetes in the Swedish Setting. Pharmacoecon Open. 2022;6(3):343-354. doi: 10.1007/s41669-021-00317-z

Guzauskas GF, Rind DM, Fazioli K, Chapman RH, Pearson SD, Hansen RN. Cost-effectiveness of oral Semaglutide added to current antihyperglycemic treatment for type 2 diabetes. J Manag Care Spec Pharm. 2021;27(4):455-468. doi: 10.18553/jmcp.2021.27.4.455

Antza C, Nirantharakumar K, Doundoulakis I, Tahrani AA, Toulis KA. The development of an oral GLP-1 receptor agonist for the management of type 2 diabetes: evidence to date. Drug Des Devel Ther. 2019;13:2985-96. doi: 10.2147/DDDT.S166765

Andersen A, Knop FK, Vilsbøll T. A Pharmacological and Clinical Overview of Oral Semaglutide for the Treatment of Type 2 Diabetes. Drugs. 2021;81(9):1003-1030. doi: 10.1007/ s40265-021-01499-w

Kurtzhals P, Flindt Kreiner F, Singh Bindra R. The role of weight control in the management of type 2 diabetes mellitus: Perspectives on Semaglutide. Diabetes Res Clin Pract. 2023;203: 110881. doi: 10.1016/j.diabres.2023. 110881

Li A, Su X, Hu S, Wang Y. Efficacy and safety of oral Semaglutide in type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2023;198:110605. doi: 10.1016/ j.diabres.2023.110605

Kim DD, Wilkinson CL, Pope EF, Chambers JD, Cohen JT, Neumann PJ. The influence of time horizon on results of cost-effectiveness analyses. Expert Rev Pharmacoecon Outcomes Res. 2017;17(6):615-623.doi: 10.1080/1473 7167.2017.1331432

Eliaschewitz FG, Canani LH. Advances in GLP-1 treatment: focus on oral Semaglutide. Diabetol Metab Syndr. 2021;13(1):99. doi: 10.1186/s13098-021-00713-9

Drost RMWA, Van Der Putten IM, Ruwaard D, Evers SMAA, Paulus ATG. Conceptualizations Of The Societal Perspective Within Economic Evaluations: A Systematic Review. Int J Technol Assess Health Care. 2017; 33(2):251-260. doi: 10.1017/S026646 2317000526

Yoshida Y, Cheng X, Shao H, Fonseca VA, Shi L. A Systematic Review of Cost-Effectiveness of Sodium-Glucose Cotransporter Inhibitors for Type 2 Diabetes. Curr Diab Rep. 2020;20(4): 12. doi: 10.1007/s11892-020-1292-5

Yang CY, Chen YR, Ou HT, Kuo S. Cost-effectiveness of GLP-1 receptor agonists versus insulin for the treatment of type 2 diabetes: a real-world study and systematic review. Cardiovasc Diabetol. 2021;20(1):21. doi: 10.1186/ s12933-020-01211-4

Bagepally BS, Chaikledkaew U, Gurav YK, Anothaisintawee T, Youngkong S, Chaiyakunapruk N, et al. Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies. BMJ Open Diabetes Res Care. 2020;8(1):e001020. doi: 10.1136/bmjdrc-2019-001020