From 7ac11416f076dfffbe1fa9e2e159a401b7104155 Mon Sep 17 00:00:00 2001 From: Teleo Agents Date: Mon, 16 Mar 2026 12:49:12 +0000 Subject: [PATCH] extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd Pentagon-Agent: Ganymede --- ...t cost impact inflationary through 2035.md | 6 ++++ ...-year-window-excludes-long-term-savings.md | 6 ++++ ...-cardiovascular-and-metabolic-endpoints.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..e62cb2268 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 (borderline). Recent Medicare pricing at $245/month and Trump-negotiated deals represent 82% discounts from list, placing actual ICERs well below cost-effectiveness thresholds. The declining price trajectory may flip GLP-1s from net inflationary to cost-saving before 2035. + --- Relevant Notes: diff --git a/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md b/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md index 757a63443..1ea98d315 100644 --- a/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md +++ b/domains/health/federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md @@ -45,6 +45,12 @@ The claim that budget scoring "systematically" undervalues prevention requires e The CBO vs. ASPE divergence on Medicare GLP-1 coverage provides concrete evidence: CBO projects $35B in additional spending (2026-2034) using budget scoring methodology, while ASPE projects net savings of $715M over 10 years using clinical economics methodology that includes downstream event avoidance. The $35.7B gap between these estimates demonstrates how budget scoring rules structurally disadvantage preventive interventions. CBO uses conservative uptake assumptions and doesn't fully count avoided hospitalizations and disease progression within the 10-year window, while ASPE includes 38,950 CV events avoided and 6,180 deaths avoided. Both are technically correct but answer different questions—budget impact vs. clinical economics. + +### Additional Evidence (confirm) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* + +SELECT lifetime horizon model shows average per-subject treatment cost of $47,353 generates $18,017 in savings from avoided complications ($14,431 T2D + $2,074 CKD + $1,512 CV), but these savings accrue over decades. A 10-year budget window would capture treatment costs but miss majority of prevention savings, systematically biasing against GLP-1 coverage expansion. + --- 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 8dab4f1bd..21a350d1e 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 @@ -36,6 +36,12 @@ For value-based care models and capitated payers, this multi-organ protection cr SELECT trial exploratory analysis (N=17,604, median 41.8 months) shows semaglutide reduces ALL-CAUSE hospitalizations by 10% (18.3 vs 20.4 per 100 patient-years, P<.001) and total hospital days by 11% (157.2 vs 176.2 days per 100 patient-years, P=.01). Critically, benefits extended beyond cardiovascular causes to total hospitalization burden, suggesting systemic effects across multiple organ systems. + +### Additional Evidence (extend) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16* + +SELECT economic model quantifies the relative value of multi-organ protection: T2D prevention generates $14,431 per-patient savings, CKD prevention $2,074, and CV events only $1,512. Diabetes prevention is the dominant economic lever, not cardiovascular protection, even in a CVD population. + --- 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..6509707e0 --- /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-depends-on-net-price-not-list-price-with-4x-variation-in-icer.md", + "issues": [ + "missing_attribution_extractor" + ] + }, + { + "filename": "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-per-patient.md", + "issues": [ + "missing_attribution_extractor" + ] + } + ], + "validation_stats": { + "total": 2, + "kept": 0, + "fixed": 2, + "rejected": 2, + "fixes_applied": [ + "glp-1-cost-effectiveness-depends-on-net-price-not-list-price-with-4x-variation-in-icer.md:set_created:2026-03-16", + "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-per-patient.md:set_created:2026-03-16" + ], + "rejections": [ + "glp-1-cost-effectiveness-depends-on-net-price-not-list-price-with-4x-variation-in-icer.md:missing_attribution_extractor", + "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-per-patient.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..756003e5a 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", "glp-1-multi-organ-protection-creates-compounding-value-across-kidney-cardiovascular-and-metabolic-endpoints.md", "federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.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 treated (lifetime): 2,791 non-fatal MIs avoided, 3,000 revascularizations avoided, 487 strokes avoided, 115 CV deaths avoided +- Australian cost-effectiveness analysis: A$96,055/QALY at A$4,175/year pricing, not cost-effective at A$50,000/QALY threshold +- ICER 2025 assessment: semaglutide and tirzepatide now meet <$100K/QALY at net prices (shift from 2022 assessment) +- Study funded by Novo Nordisk with 48% rebate assumption based on their internal net pricing estimates