Glucagon-like peptide-1 receptor agonist (GLP-1 RA) effectively manages blood sugar levels and weight, and offers cardiovascular protection for type 2 diabetes mellitus (T2DM). Compared to injection GLP-1 RA, oral medications provide the advantages of easy use and improved patient adherence. This study aimed to assess the cost-effectiveness of oral semaglutide as a second-line treatment from the perspective of healthcare payer in Taiwan.

The study population was T2DM patients with cardiovascular disease who received metformin but still had inadequate glycemic control. Intervention was oral semaglutide, and the comparators included liraglutide and dulaglutide. The IQVIA CORE Diabetes Model (version 9.0) was used to simulate the progression of diabetes. Baseline characteristics, including age, DM duration, and HbA1c level, were from the Taiwan Diabetes Registry Database. Clinical efficacy data were obtained from the PIONEER 4 (Asian populations) and PIONEER 10. Management costs and diabetic related complications were obtained from the National Health Insurance claims data. Prices were 2020, and discounts were 3% for cost and effectiveness. Probabilistic sensitivity analyses (PSA) were conducted.

Oral semaglutide resulted in an increase of 0.13 quality-adjusted life years (QALYs) and an additional cost of US$2,955, leading to an incremental cost-effectiveness ratio (ICER) of US$22,764 per QALY gained when compared to liraglutide. In comparison to dulaglutide, it enhanced QALYs by 0.02 and incurred an additional cost of US$703, resulting in an ICER of US$39,249 per QALY gained. When applying a willingness-to-pay threshold of three times Taiwan’s 2020 GDP per capita (US$83,798), the probabilities of oral semaglutide being cost-effective were 69.3% and 52.9% compared to liraglutide and dulaglutide, respectively.

Oral semaglutide could be a cost-effective treatment option for T2DM patients who have major cardiovascular events and have already been treated with metformin but still face inadequate glycemic control.