extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd

Pentagon-Agent: Ganymede <F99EBFA6-547B-4096-BEEA-1D59C3E4028A>

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.
+
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 Relevant Notes:

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:

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:

inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json

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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]
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+processed_date: 2026-03-16
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 ---
 
 ## 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