Cost-effectiveness analysis of oral semaglutide versus subcutaneous dulaglutide in patients with type 2 diabetes mellitus: A Markov model study.

AIM: This study assessed the cost-effectiveness of oral semaglutide versus subcutaneous dulaglutide for type 2 diabetes mellitus (T2DM) from the perspective of the Taiwanese healthcare payer, considering the self-paid status of oral semaglutide and the reimbursed but injectable route of dulaglutide under the National Health Insurance (NHI).

METHODS

A Markov decision-analytic model simulated clinical and economic outcomes over a 10-year horizon. Transition probabilities, utilities, and treatment costs were derived from clinical trials, national databases, and expert consensus. Costs and health outcomes were discounted at 3% annually. The willingness-to-pay (WTP) threshold was set at US$33,983, reflecting per capita gross domestic product in Taiwan. Probabilistic and one-way sensitivity analyses evaluated model robustness.

RESULTS

Oral semaglutide was dominant, yielding an incremental gain of 0.33 quality-adjusted life years (QALYs) and reducing costs by US$1,137 compared with dulaglutide, with an incremental cost-utility ratio of -US$3,478.66/QALYs. Sensitivity analyses confirmed the robustness, with a 96.5% probability of cost-effectiveness across all WTP thresholds. Cost differences were most sensitive to drug price, particularly in patients without cardiovascular disease.

CONCLUSION

Oral semaglutide demonstrated higher clinical effectiveness and strong economic favorability relative to dulaglutide, supporting its potential inclusion in Taiwan NHI formulary to optimize the allocation of healthcare resources in T2DM.