From 0203409b87b055b5abff614730da5b47387d7535 Mon Sep 17 00:00:00 2001 From: Teleo Agents Date: Mon, 16 Mar 2026 11:30:58 +0000 Subject: [PATCH] extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd Pentagon-Agent: Ganymede --- ...t cost impact inflationary through 2035.md | 6 ++++ ...-cardiovascular-and-metabolic-endpoints.md | 6 ++++ ...eating-largest-per-patient-cost-savings.md | 6 ++++ ...st-effectiveness-analysis-obesity-cvd.json | 32 +++++++++++++++++++ ...cost-effectiveness-analysis-obesity-cvd.md | 13 +++++++- 5 files changed, 62 insertions(+), 1 deletion(-) create mode 100644 inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json diff --git a/domains/health/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.md b/domains/health/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.md index 329db7879..42974e3e2 100644 --- a/domains/health/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.md +++ b/domains/health/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.md @@ -35,6 +35,12 @@ The Cell Press review characterizes GLP-1s as marking a 'system-level redefiniti MA plans' near-universal prior authorization creates administrative friction that may worsen the already-poor adherence rates for GLP-1s. PA requirements ensure only T2D-diagnosed patients can access, effectively blocking obesity-only coverage despite FDA approval. This access restriction compounds the chronic-use economics challenge by adding administrative barriers on top of existing adherence problems. + +### Additional Evidence (challenge) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* + +SELECT trial cost-effectiveness analysis shows semaglutide achieves $32,219/QALY at 48% rebated prices (highly cost-effective) versus $136,271/QALY at list price (marginally cost-effective). Medicare deal at $245/month represents 82% price reduction. The inflationary impact claim may need scope qualification: GLP-1s are inflationary at list prices but potentially cost-saving at negotiated net prices, and recent price trajectory suggests faster-than-expected flip to cost-effectiveness. + --- Relevant Notes: diff --git a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md index 1222d36b5..c8856e293 100644 --- a/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md +++ b/domains/health/glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md @@ -30,6 +30,12 @@ For value-based care models and capitated payers, this multi-organ protection cr - Nature Medicine: additive benefits with SGLT2 inhibitors - First GLP-1 to receive FDA indication for CKD in T2D patients + +### Additional Evidence (confirm) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* + +SELECT trial modeling shows multi-organ savings hierarchy: T2D prevention $14,431, CKD prevention $2,074, CV event prevention $1,512 per subject lifetime. The compounding value exists but is heavily weighted toward metabolic protection (diabetes + kidney = $16,505) versus cardiovascular ($1,512). + --- Relevant Notes: diff --git a/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md b/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md index 5299ec097..73e08fb4c 100644 --- a/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md +++ b/domains/health/semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md @@ -28,6 +28,12 @@ This is the first dedicated kidney outcomes trial with a GLP-1 receptor agonist, - FDA indication expansion to T2D patients with CKD (2024) - Dialysis cost benchmark: $90K+/year per patient + +### Additional Evidence (extend) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* + +SELECT trial economic modeling quantifies CKD prevention savings at $2,074 per subject lifetime, which is 1.4x the CV event savings ($1,512) but only 14% of the diabetes prevention savings ($14,431). The kidney protection value is real but secondary to metabolic disease prevention in the economic hierarchy. + --- Relevant Notes: diff --git a/inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json b/inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json new file mode 100644 index 000000000..e3d8a5c2c --- /dev/null +++ b/inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json @@ -0,0 +1,32 @@ +{ + "rejected_claims": [ + { + "filename": "glp-1-cost-effectiveness-is-price-dependent-with-rebated-prices-achieving-32k-per-qaly-versus-136k-at-list-price.md", + "issues": [ + "missing_attribution_extractor" + ] + }, + { + "filename": "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-making-metabolic-protection-the-primary-economic-lever.md", + "issues": [ + "missing_attribution_extractor" + ] + } + ], + "validation_stats": { + "total": 2, + "kept": 0, + "fixed": 2, + "rejected": 2, + "fixes_applied": [ + "glp-1-cost-effectiveness-is-price-dependent-with-rebated-prices-achieving-32k-per-qaly-versus-136k-at-list-price.md:set_created:2026-03-16", + "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-making-metabolic-protection-the-primary-economic-lever.md:set_created:2026-03-16" + ], + "rejections": [ + "glp-1-cost-effectiveness-is-price-dependent-with-rebated-prices-achieving-32k-per-qaly-versus-136k-at-list-price.md:missing_attribution_extractor", + "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-making-metabolic-protection-the-primary-economic-lever.md:missing_attribution_extractor" + ] + }, + "model": "anthropic/claude-sonnet-4.5", + "date": "2026-03-16" +} \ No newline at end of file diff --git a/inbox/archive/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.md b/inbox/archive/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.md index 73cfb598d..12e0ead83 100644 --- a/inbox/archive/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.md +++ b/inbox/archive/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.md @@ -7,9 +7,13 @@ date: 2025-01-01 domain: health secondary_domains: [internet-finance] format: paper -status: unprocessed +status: enrichment priority: medium tags: [glp-1, semaglutide, cost-effectiveness, cardiovascular, SELECT-trial, QALY] +processed_by: vida +processed_date: 2026-03-16 +enrichments_applied: ["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.md", "semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md", "glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md"] +extraction_model: "anthropic/claude-sonnet-4.5" --- ## Content @@ -43,3 +47,10 @@ Cost-effectiveness analysis of semaglutide 2.4mg based on SELECT trial data, mod 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 + + +## Key Facts +- SELECT trial per 100,000 subjects (lifetime): 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 +- Australian analysis: at A$4,175/year, ICER = A$96,055/QALY (~US$138K/QALY), not cost-effective at A$50K threshold +- ICER 2025: semaglutide would need 80% price reduction to meet standard threshold at list price