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P1146 - Oral Semaglutide Provides Less Value for Money Than Subcutaneous Semaglutide for the Prevention of Major Adverse Cardiovascular Events, but Significantly More Value for Money for the Prevention of Cardiovascular Mortality

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Author Block: Ronen Arbel, Enis Aboalhasan, Sapir Coll, Sderot, Israel; Ariel Hammerman, Clalit Health Services, Tel Aviv, Israel; Joseph Azuri, Sackler Faculty of Med, Tel Aviv Univ, Tel Aviv, Israel
Disclosure Block: R.Arbel: None. E.Aboalhasan: None. A.Hammerman: None. J.Azuri: Honoraria; Modest; Pfizer, Novonordisk, Other Research Support; Modest; Janssen Pharmaceutica.
Introduction: Semaglutide, a subcutaneous Glucagon-Like Peptide-1 receptor agonist, reduces the risk of major adverse cardiovascular events (MACE) in patients with Type 2 diabetes mellitus (T2DM). An oral version of semaglutide is now available, and patients may prefer it over a subcutaneous injection. The value for money of the oral version for the prevention of MACE is not clear. Hypothesis: Oral semaglutide provides less value for money than subcutaneous semaglutide for the prevention of MACE, but more value for money for the prevention of the single endpoint of cardiovascular mortality (CVM). Methods: We calculated the cost needed to prevent (CNT) one MACE, by multiplying the one-year number needed to treat to prevent one event, by the annual cost of the therapy. Efficacy estimates were extracted from published RCT data. The CNT to prevent one event of the single endpoint of CVM was analyzed as a secondary outcome. We performed a sensitivity analysis to mitigate primary differences between the RCTs. Drug costs were calculated as 75% of the US National Average Drug Acquisition Cost listing in June 2020. Results: The CNT to prevent one MACE with subcutaneous semaglutide in SUSTAIN-6 is $641,823 ($402,021-$3,533,533) compared to $855,040 (95% CI: $420,840-∞) with oral semaglutide in PIONEER 6. The lower cost of subcutaneous semaglutide was confirmed in a sensitivity analysis simulating the effects of the drugs in both RCTs. The CNT to prevent one CVM with semaglutide is $16,342,560 ($2,020,704.00-∞) compared to $1,315,720 (95% CI: $921,004-$8,392,414) with oral semaglutide. Conclusions: Subcutaneous semaglutide prescribed for the prevention of MACE in patients with T2DM is moderately cost-saving compared to oral semaglutide for the same purpose. However, for the prevention of CVM, the oral version provides significantly better economic value.