Novo Nordisk A/S, Søborg, Denmark.
Novo Nordisk Inc, Plainsboro, NJ, USA.
J Med Econ. 2020 Jun;23(6):650-658. doi: 10.1080/13696998.2020.1722678. Epub 2020 Feb 7.
The efficacy and safety of oral semaglutide, the first glucagon-like peptide-1 (GLP-1) receptor agonist developed for oral administration for the treatment of type 2 diabetes, was evaluated in the PIONEER clinical trial program, and a recently published network meta-analysis allowed comparison with further injectable GLP-1 receptor agonists. The present study aimed to assess the short-term cost- effectiveness of oral semaglutide 14 mg versus subcutaneous once-weekly dulaglutide 1.5 mg, once-weekly exenatide 2 mg, twice-daily exenatide 10 µg, once-daily liraglutide 1.8 mg, once-daily lixisenatide 20 µg, and once-weekly semaglutide 1 mg, in terms of the cost per patient achieving glycated hemoglobin (HbA1c) targets (cost of control). Cost of control was calculated by dividing the annual treatment costs associated with an intervention by the proportion of patients achieving the treatment target with an intervention, with outcomes calculated for targets of HbA1c ≤6.5% and HbA1c <7.0% for all included GLP-1 receptor agonists. Annual treatment costs were accounted in 2019 United States dollars (USD), based on 2019 wholesale acquisition cost. For the treatment target of HbA1c ≤6.5%, once-weekly semaglutide 1 mg and oral semaglutide 14 mg were associated with the lowest costs of control, at USD 15,430 and USD 17,383 per patient achieving target, respectively. Similarly, the cost of control was lowest with once-weekly semaglutide 1 mg at USD 12,627 per patient achieving target, followed by oral semaglutide 14 mg at USD 13,493 per patient achieving target for the target of HbA1c <7.0%. All other interventions were associated with higher cost of control values for both targets. Oral semaglutide 14 mg is likely to be cost-effective versus dulaglutide, exenatide (once weekly and twice daily), liraglutide, and lixisenatide in terms of bringing people with type 2 diabetes to glycemic control targets of HbA1c ≤6.5% and HbA1c <7.0% in the US.
口服司美格鲁肽是首个开发用于治疗 2 型糖尿病的口服胰高血糖素样肽-1（GLP-1）受体激动剂，其疗效和安全性已在 PIONEER 临床试验项目中得到评估，最近发表的一项网络荟萃分析允许将其与其他可注射 GLP-1 受体激动剂进行比较。本研究旨在评估口服司美格鲁肽 14mg 与皮下注射每周一次度拉糖肽 1.5mg、每周一次艾塞那肽 2mg、每日两次艾塞那肽 10μg、每日一次利拉鲁肽 1.8mg、每日一次利西那肽 20μg 和每周一次司美格鲁肽 1mg 治疗 2 型糖尿病患者达到糖化血红蛋白（HbA1c）目标（控制成本）的短期成本效益。控制成本是通过将与干预相关的年度治疗成本除以干预后达到治疗目标的患者比例来计算的，所有纳入的 GLP-1 受体激动剂的结果均以 HbA1c≤6.5%和 HbA1c<7.0%为目标。年度治疗成本以 2019 年的 2019 年批发采购成本为基础，换算成 2019 年的美元（USD）。对于 HbA1c≤6.5%的治疗目标，每周一次司美格鲁肽 1mg 和口服司美格鲁肽 14mg 的控制成本最低，分别为每位患者达到目标的 15430 美元和 17383 美元。同样，每周一次司美格鲁肽 1mg 的控制成本最低，每位患者达到目标的成本为 12627 美元，其次是口服司美格鲁肽 14mg，每位患者达到目标的成本为 13493 美元，用于 HbA1c<7.0%的目标。对于这两个目标，所有其他干预措施的控制成本都较高。在将 2 型糖尿病患者血糖控制在 HbA1c≤6.5%和 HbA1c<7.0%的目标方面，口服司美格鲁肽 14mg 可能比度拉糖肽、艾塞那肽（每周一次和每日两次）、利拉鲁肽和利西那肽更具成本效益。
