Semaglutide cost-acceptable vs. dulaglutide for Type 2 Diabetes in China, ¥174,904 ICER per QALY.

Type 2 Diabetes Mellitus (T2DM) represents a significant public health challenge globally, with China facing a particularly high burden. Effective long-term management is crucial to prevent complications, yet treatment choices must balance clinical efficacy with economic viability, especially within public health insurance systems. Glucagon-like peptide-1 receptor (GLP-1R) agonists like semaglutide and dulaglutide offer superior glycemic control and cardiovascular benefits, but their higher cost necessitates rigorous pharmacoeconomic evaluation to inform national health policy and ensure sustainable access.

Researchers utilized a Markov model to simulate the progression of T2DM over a 25-year time horizon, comparing semaglutide against dulaglutide from the perspective of China's basic medical insurance. Transition probabilities between health states were derived from the UK Prospective Diabetes Study Outcomes Model (UKPDS 82) and the SUSTAIN 7 clinical trial. Health utility values were sourced from published literature using the Chinese EQ-5D-5L value set. Both one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted to assess the robustness of the model's long-term cost-effectiveness projections.

After a 25-year simulation period, the total cost for dulaglutide was ¥193,353.07, yielding 11.628 quality-adjusted life-years (QALYs). In comparison, semaglutide incurred a total cost of ¥240,925.08, resulting in 11.900 QALYs.

Compared with dulaglutide, semaglutide demonstrated an incremental cost-effectiveness ratio (ICER) of ¥174,904 per QALY gained, which is approximately twice China's 2023 per capita GDP (¥89,358). According to the Chinese Guidelines for Pharmacoeconomic Evaluation (2020), this ICER falls within the economically acceptable range (1 × GDP < ICER ≤ 3 × GDP). One-way sensitivity analysis confirmed the model's robustness, despite health state utility values being the most influential parameter. PSA further indicated that at a willingness-to-pay (WTP) threshold of 3 times the per capita GDP (¥268,074), semaglutide had an 89.6% probability of being considered economically acceptable.