For overweight or obese individuals without diabetes, but with pre-existing cardiovascular disease, semaglutide (Ozempic, Wegovy) is not cost-effective at current pricing, new research shows. However, with price reductions or rebates up to 50%, it could meet the benchmark for value in healthcare. An article in the Canadian Journal of Cardiology, published by Elsevier, details a statistical model analyzing the cost-effectiveness of semaglutide. It provides evidence for policymakers considering the benefits of funding semaglutide for individuals without diabetes and the budgetary impact for long-term health gains.

Obesity is a global epidemic. By 2035, more than half of the world is expected to be overweight or obese. Being overweight or obese is associated with increased risk of adverse cardiovascular events even after considering metabolic risk factors, and more than two thirds of deaths related to elevated body mass index (BMI) are caused by cardiovascular diseases.

The demand for semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) commonly known under the brand names Ozempic and Wegovy, has surged in recent years, especially for weight loss. It not only regulates blood sugar, but also reduces appetite and slows digestion. In Canada, it is currently only funded for individuals with diabetes. Researchers from the University of Calgary undertook a statistical analysis to estimate the lifetime benefit and costs of semaglutide use compared to no semaglutide use in overweight or obese individuals without diabetes, but with pre-existing cardiovascular disease.

Lead investigator Derek Chew, MD, MSc, Cumming School of Medicine, University of Calgary, explains, "Our economic model compared the difference in lifetime costs (including drug costs, hospitalizations, and other significant health events) and difference in life expectancy adjusted for patient quality of life between those treated with semaglutide and those who did not receive semaglutide. The main finding is that at current pricing, semaglutide is not cost-effective. However, with price reductions or rebates of up to 50%, semaglutide could meet the benchmark for value in healthcare."

The study's decision analysis entailed utilizing an analytical framework, tracking probabilities of different disease states, and data from the SELECT trial (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity, which showed the cardiac benefits for non-diabetic individuals in the studied cohort using weekly semaglutide injections) to identify the incremental cost-effectiveness ratios and quality-adjusted life years (QALYs) gained from semaglutide therapy for the treatment of obesity versus usual care.

Using the conventional benchmark of CAN$50,000/QALY gained (i.e., CAN$50,000 or less to increase a person’s quality of life and/or life expectancy by one year is considered acceptable healthcare value for money), the base case analysis demonstrated that the incremental cost-effectiveness ratio for semaglutide compared to standard care was CAN$72,962/QALY gained with a 14% probability of meeting the CAN$50,000/QALY benchmark. Factors with the greatest impact on estimated cost-effectiveness were medication impact on mortality and medication cost. When the price of semaglutide was reduced by 50%, it was economically attractive at CAN$37,190/QALY gained with an 80% likelihood of cost-effectiveness at a CAN$50,000/QALY threshold.

Co-lead investigator Elissa Rennert-May, MD, Cumming School of Medicine, University of Calgary, notes, "Our study's results are important because public drug plans are considering whether to fund GLP1 RAs for use in individuals without diabetes."

In an accompanying editorial "Spending Money, Saving Money We Don't Got: The Cost of Obesity," James A. Stone, MD, PhD, FRCPC, Clinical Professor of Medicine, Cumming School of Medicine, University of Calgary, says, "Cardiovascular specialists, and practically speaking, most clinicians and healthcare decision makers, have a limited knowledge of health economics. The nuances and the finer details of health economics with respect to cost-effectiveness, incremental cost-effectiveness ratios, cost-utility, quality-adjusted life years, cost-benefit analysis, productivity, efficiency, and effectiveness are mostly a black hole to be safely skirted around. Spending money on disease prevention is an investment in the long-term value of a population’s health, in contradistinction to the rather short-term value of an individual’s disease care."

Ana P. Johnson, PhD, Professor, Department of Health Sciences, Queen’s University, and co-author of the editorial, adds, "It can be exceedingly difficult to change the healthcare payer’s perspective with regard to investing in disease prevention, rather than disease treatment, when the return on the dollars invested, through adverse event reductions, may not accrue for decades."

Dr. Chew concludes, "Now that there is emerging high-quality evidence for semaglutide and its positive impact on weight loss and associated cardiovascular outcomes in individuals without diabetes, its cost-effectiveness and potential funding by healthcare insurance should be reconsidered. Our model is generalizable across Canada, and while healthcare-associated costs vary in different countries, our model and assumptions could be broadly applied to many jurisdictions."