Once-weekly Semaglutide 2.4 mg deemed cost-effective for obesity management in Spain's health system

The escalating prevalence of obesity and overweight poses a significant challenge to national health systems, driving up healthcare costs and increasing the burden of associated co-morbidities like type 2 diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease (MASLD). Current standard-of-care often involves lifestyle interventions, which, while crucial, frequently fall short in achieving sustained weight loss for many individuals. Glucagon-like peptide 1 (GLP-1) analogues, such as semaglutide, represent a promising therapeutic class by targeting GLP-1R to enhance satiety, reduce appetite, and improve metabolic parameters, offering a more effective pharmacological adjunct to lifestyle changes.

Researchers conducted a model-based cost-effectiveness analysis using version 26 of the Core Obesity Model, a Markov state transition model, to project health outcomes and costs over 40 years. The study compared semaglutide 2.4 mg once-weekly subcutaneous injection combined with diet and exercise (D&E) against D&E alone for adults with obesity (BMI ≥30 kg/m2) in Spain. Efficacy and safety data were sourced from the STEP 1 trial, which involved a cohort of adults with an average age of 46 years. The analysis adopted the perspective of the Spanish National Health System (NHS), focusing solely on direct healthcare costs. The primary endpoint was the cost per quality-adjusted life year (QALY) gained, with robustness confirmed via univariate and probabilistic sensitivity analyses.

Compared to diet and exercise alone, semaglutide 2.4 mg in combination with D&E generated an additional 0.1049 QALYs over a 40-year time horizon. This therapeutic approach also resulted in a €2685 increase in direct healthcare costs over the same period. These figures led to an incremental cost-effectiveness ratio (ICER) of €25,589/QALY. This ICER was evaluated against a commonly accepted cost-effectiveness threshold of €30,000/QALY in Spain. > Semaglutide 2.4 mg was found to be cost-effective, falling below the €30,000/QALY threshold. The robustness of this finding was consistently confirmed through extensive univariate and probabilistic sensitivity analyses, underscoring the reliability of the model's conclusions across various scenarios and parameter uncertainties.