---
type: source
title: "Cost-effectiveness of Semaglutide in People with Obesity and Cardiovascular Disease Without Diabetes"
author: "Journal of Medical Economics (Tandfonline)"
url: https://www.tandfonline.com/doi/full/10.1080/13696998.2025.2459529
date: 2025-01-01
domain: health
secondary_domains: [internet-finance]
format: paper
status: unprocessed
priority: medium
tags: [glp-1, semaglutide, cost-effectiveness, cardiovascular, SELECT-trial, QALY]
---

## Content

Cost-effectiveness analysis of semaglutide 2.4mg based on SELECT trial data, modeling lifetime outcomes for obese/overweight patients with established CVD but without diabetes.

**Key findings:**
- At list price: ICER = $136,271/QALY — cost-effective at $150,000/QALY threshold
- With estimated 48% rebate: ICER = $32,219/QALY — highly cost-effective
- Per 100,000 subjects treated (lifetime horizon): 2,791 non-fatal MIs avoided, 3,000 revascularizations avoided, 487 strokes avoided, 115 CV deaths avoided
- Average per-subject lifetime treatment cost: $47,353
- Savings from avoided T2D: $14,431/subject; avoided CKD: $2,074; avoided CV events: $1,512

**Australian analysis comparison:**
- At A$4,175/year: ICER = A$96,055/QALY (~US$138K/QALY)
- NOT cost-effective at Australian A$50,000/QALY threshold

**ICER 2025 assessment:**
- Semaglutide and tirzepatide now meet <$100K/QALY at net prices (shift from 2022)
- But semaglutide would need 80% price reduction to meet standard threshold at list price

## Agent Notes
**Why this matters:** The rebate-adjusted ICER ($32K/QALY) vs. list-price ICER ($136K/QALY) shows that the cost-effectiveness conclusion depends almost entirely on the actual net price. At $245/month (Medicare deal), semaglutide is likely highly cost-effective. At $1,350/month (list), it's borderline. This price sensitivity means the Trump deals fundamentally change the cost-effectiveness calculation.
**What surprised me:** The per-subject savings from avoided T2D ($14,431) dwarf savings from avoided CV events ($1,512), even though the trial was a CV outcomes trial. Diabetes prevention may be the largest economic lever, not cardiovascular protection.
**What I expected but didn't find:** No analysis stratified by risk level. High-risk patients (those meeting Medicare eligibility criteria) likely have much better cost-effectiveness than the average SELECT population.
**KB connections:** Supports scope-qualifying the inflationary claim — GLP-1s are cost-effective at net prices but not at list prices. The price trajectory (declining) matters enormously.
**Extraction hints:** The T2D prevention savings being 10x the CV event savings is a key insight. The existing GLP-1 claim focuses on weight loss economics; the real economic case may be metabolic disease prevention.
**Context:** Industry-funded study (Novo Nordisk). The 48% rebate estimate is their assumption of actual net pricing. CBO and ASPE use different assumptions.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: Cost-effectiveness is price-dependent — the declining price trajectory may flip GLP-1s from inflationary to cost-effective faster than the existing claim anticipates
EXTRACTION HINT: Focus on the price sensitivity of the cost-effectiveness conclusion and how recent price deals change the math
