Cost-Effectiveness of Once-Weekly Semaglutide 1.0 mg vs. Dulaglutide 1.5 mg as Add-On to Metformin in the Treatment of Type 2 Diabetes in Canada
Bibliographic record
Abstract
Semaglutide is a novel GLP-1R agonist with prolonged half-life due to enhanced binding to albumin and inhibition of degradation by dipeptidyl peptidase-4. SUSTAIN 7, an open-label, parallel-group, phase 3b trial of 1,201 individuals with type 2 diabetes inadequately controlled on metformin monotherapy compared semaglutide to dulaglutide over 40 weeks. Semaglutide 1.0 mg demonstrated statistical superiority to dulaglutide 1.5 mg in HbA1c lowering (-1.8% vs. -1.4% [ETD -0.41%; 95% CI -0.57 to -0.25]) and reductions in body weight (-6.5 kg vs. -3.0 kg [ETD -3.55 kg; -4.32 to -2.78]). We used a validated non-product specific cost-effectiveness cohort model (the IHE Cohort Model of Type 2 Diabetes) to extrapolate outcomes and costs associated with semaglutide 1.0 mg vs. dulaglutide 1.5 mg over a 40-year time horizon. Treatment effects (e.g., HbA1c, BMI, and systolic blood pressure) as well as cohort characteristics were sourced from SUSTAIN 7. Treatment with semaglutide 1.0 mg and dulaglutide 1.5 mg were assumed to continue for three years, after which the cohort discontinued the initial treatments, and started insulin therapy. Costs and health-related quality of life impact associated with developing macro- and microvascular complications were sourced from a Canadian perspective where possible. In the base case, semaglutide 1.0 mg was associated with fewer micro- and macrovascular complications (driven by observed differences in risk factors). For example, for every 1,000 individuals, four fewer patients in the semaglutide 1.0 mg arm were simulated to experience a stroke. Fewer events led to an increase in quality-adjusted life years of 0.05 at lower total costs for patients in the semaglutide 1.0 mg arm compared to the dulaglutide 1.5 mg arm. Results were tested in sensitivity analyses and found to be robust, suggesting that semaglutide 1.0 mg provides better health outcomes at a lower cost, compared to dulaglutide 1.5 mg. Disclosure P. Johansen: Consultant; Self; Janssen Global Services, LLC.. Employee; Self; Novo Nordisk A/S. J. Håkan-Bloch: Employee; Self; Novo Nordisk A/S. Employee; Spouse/Partner; Novo Nordisk A/S. A.R. Liu: None. S. Persson: None. E. Toresson Grip: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".