Silva Miguel Luís, Soares Mariana, Olivieri Anamaria, Sampaio Filipa, Lamotte Mark, Shukla Suramya, Conde Vasco, Freitas Paula, Costa João, Borges Margarida
IQVIA, Lisbon, Portugal.
IQVIA, Basel, Switzerland.
Diabetol Metab Syndr. 2024 Apr 30;16(1):97. doi: 10.1186/s13098-024-01338-4.
Obesity and overweight are a significant public health concern. Subcutaneous semaglutide 2.4 mg injection is a glucagon-like peptide-1 (GLP-1) analogue approved by the European Medicines Agency as an adjunct to a reduced calorie diet and increased physical activity (diet and exercise, D&E) for the treatment obesity and overweight in the presence of at least one weight related comorbidity. This study aimed to assess the cost-effectiveness of semaglutide 2.4 mg in combination with D&E compared to D&E alone for the Portuguese setting.
Analysis were conducted using the Core Obesity Model (COM) version 18, a Markov state transition cohort model, to predict the health outcomes and costs of weight related complications based on changes in surrogate endpoints. Efficacy and safety data were sourced from the STEP trials (Body Mass Index, systolic blood pressure and glycemic status) from a cohort of adults aged on average 48 years with obesity (BMI ≥ 30 kg/m2) and ≥ 1 obesity-related comorbidities, over a time horizon of 40 years. Costs were estimated from the perspective of the Portuguese National Health Service. Sensitivity analyses were conducted to test the robustness of results across a range of assumptions.
On a patient level, Semaglutide 2.4 mg in addition to D&E compared to D&E alone, improved QALYs by 0.098 and yielded higher costs by 1,325 EUR over a 40-year time horizon, with an ICER of 13,459 EUR per QALY gained and 100% probability of cost-effectiveness at the given WTP. Semaglutide 2.4 mg remained cost-effective across all different scenarios and sensitivity analysis at a WTP of 20,000 EUR per QALY. Among the subpopulations examined, Semaglutide 2.4 mg yielded ICERs of 18,459 EUR for patients with BMI ≥ 30 kg/m2 and of 22,657 EUR for patients with BMI ≥ 35 kg/m2.
Semaglutide 2.4 mg was cost-effective compared to D&E alone for patients with obesity (BMI ≥ 30 kg/m2) and weight related comorbidities in Portugal, over a 40-year time horizon.
肥胖和超重是重大的公共卫生问题。皮下注射司美格鲁肽2.4毫克是一种胰高血糖素样肽-1（GLP-1）类似物，已获欧洲药品管理局批准，作为低热量饮食和增加体力活动（饮食和运动，D&E）的辅助手段，用于治疗存在至少一种与体重相关合并症的肥胖和超重。本研究旨在评估在葡萄牙环境下，与单独的饮食和运动相比，2.4毫克司美格鲁肽联合饮食和运动的成本效益。
使用核心肥胖模型（COM）第18版（一种马尔可夫状态转换队列模型）进行分析，以根据替代终点的变化预测与体重相关并发症的健康结果和成本。疗效和安全性数据来自STEP试验（体重指数、收缩压和血糖状态），该试验针对平均年龄48岁、患有肥胖症（BMI≥30kg/m2）且至少有一种肥胖相关合并症的成年人群体，时间跨度为40年。成本从葡萄牙国家卫生服务的角度进行估算。进行敏感性分析以检验一系列假设下结果的稳健性。
在患者层面，与单独的饮食和运动相比，2.4毫克司美格鲁肽联合饮食和运动在40年的时间跨度内，使质量调整生命年（QALY）提高了0.098，成本增加了1325欧元，每获得一个QALY的增量成本效益比（ICER）为13459欧元，在给定的支付意愿（WTP）下具有100%的成本效益可能性。在每个QALY支付意愿为20000欧元的情况下，2.4毫克司美格鲁肽在所有不同情景和敏感性分析中均保持成本效益。在所研究的亚组中，对于BMI≥30kg/m2的患者，2.4毫克司美格鲁肽的ICER为18459欧元，对于BMI≥35kg/m2的患者，ICER为22657欧元。
在葡萄牙，对于肥胖症（BMI≥30kg/m2）且患有与体重相关合并症的患者，在40年的时间跨度内，与单独的饮食和运动相比，2.4毫克司美格鲁肽具有成本效益。
