extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd
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Teleo Agents
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@ -23,6 +23,12 @@ The competitive dynamics (Lilly vs. Novo vs. generics post-2031) will drive pric
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Real-world persistence data from 125,474 commercially insured patients shows the chronic use model fails not because patients choose indefinite use, but because most cannot sustain it: only 32.3% of non-diabetic obesity patients remain on GLP-1s at one year, dropping to approximately 15% at two years. This creates a paradox for payer economics—the "inflationary chronic use" concern assumes sustained adherence, but the actual problem is insufficient persistence. Under capitation, payers pay for 12 months of therapy ($2,940 at $245/month) for patients who discontinue and regain weight, capturing net cost with no downstream savings from avoided complications. The economics only work if adherence is sustained AND the payer captures downstream benefits—with 85% discontinuing by two years, the downstream cardiovascular and metabolic savings that justify the cost never materialize for most patients.
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### Additional Evidence (challenge)
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*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-15*
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At net prices with 48% rebate, semaglutide achieves ICER of $32,219/QALY (highly cost-effective), and Medicare's $245/month deal (~82% discount) would place it well below cost-effectiveness thresholds. The inflationary impact claim may need scope qualification: GLP-1s are inflationary at list prices but potentially cost-saving at actual net prices, and the declining price trajectory may flip the net cost impact faster than 2035.
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---
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Relevant Notes:
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@ -30,6 +30,12 @@ For value-based care models and capitated payers, this multi-organ protection cr
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- Nature Medicine: additive benefits with SGLT2 inhibitors
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- First GLP-1 to receive FDA indication for CKD in T2D patients
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### Additional Evidence (extend)
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*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-15*
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Quantified lifetime savings show diabetes prevention ($14,431/subject) as the dominant economic benefit, exceeding CKD savings ($2,074) by 7x and CV event savings ($1,512) by 9.5x. The compounding value is real but asymmetric: metabolic disease prevention drives the economic case more than cardiovascular or renal protection.
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---
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Relevant Notes:
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@ -28,6 +28,12 @@ This is the first dedicated kidney outcomes trial with a GLP-1 receptor agonist,
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- FDA indication expansion to T2D patients with CKD (2024)
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- Dialysis cost benchmark: $90K+/year per patient
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### Additional Evidence (challenge)
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*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-15*
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SELECT trial modeling shows CKD savings of $2,074/subject versus T2D prevention savings of $14,431/subject. Diabetes prevention, not kidney disease delay, creates the largest per-patient cost savings in this population.
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---
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Relevant Notes:
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@ -0,0 +1,32 @@
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{
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"rejected_claims": [
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{
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"filename": "semaglutide-cost-effectiveness-depends-on-net-price-not-list-price-with-48-percent-rebate-creating-32k-per-qaly-versus-136k-at-list.md",
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"issues": [
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"missing_attribution_extractor"
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]
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},
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{
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"filename": "semaglutide-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-with-14431-per-subject-from-avoided-t2d-versus-1512-from-cv-events.md",
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"issues": [
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"missing_attribution_extractor"
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]
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}
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],
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"validation_stats": {
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"total": 2,
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"kept": 0,
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"fixed": 2,
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"rejected": 2,
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"fixes_applied": [
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"semaglutide-cost-effectiveness-depends-on-net-price-not-list-price-with-48-percent-rebate-creating-32k-per-qaly-versus-136k-at-list.md:set_created:2026-03-15",
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"semaglutide-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-with-14431-per-subject-from-avoided-t2d-versus-1512-from-cv-events.md:set_created:2026-03-15"
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],
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"rejections": [
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"semaglutide-cost-effectiveness-depends-on-net-price-not-list-price-with-48-percent-rebate-creating-32k-per-qaly-versus-136k-at-list.md:missing_attribution_extractor",
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"semaglutide-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-with-14431-per-subject-from-avoided-t2d-versus-1512-from-cv-events.md:missing_attribution_extractor"
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]
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},
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"model": "anthropic/claude-sonnet-4.5",
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"date": "2026-03-15"
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}
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@ -7,9 +7,13 @@ date: 2025-01-01
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domain: health
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secondary_domains: [internet-finance]
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format: paper
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status: unprocessed
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status: enrichment
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priority: medium
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tags: [glp-1, semaglutide, cost-effectiveness, cardiovascular, SELECT-trial, QALY]
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processed_by: vida
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processed_date: 2026-03-15
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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", "semaglutide-reduces-kidney-disease-progression-24-percent-and-delays-dialysis-creating-largest-per-patient-cost-savings.md"]
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extraction_model: "anthropic/claude-sonnet-4.5"
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---
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## Content
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@ -43,3 +47,12 @@ Cost-effectiveness analysis of semaglutide 2.4mg based on SELECT trial data, mod
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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]]
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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
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EXTRACTION HINT: Focus on the price sensitivity of the cost-effectiveness conclusion and how recent price deals change the math
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## Key Facts
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- SELECT trial modeling: per 100,000 subjects treated (lifetime horizon): 2,791 non-fatal MIs avoided, 3,000 revascularizations avoided, 487 strokes avoided, 115 CV deaths avoided
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- Average per-subject lifetime treatment cost for semaglutide 2.4mg: $47,353
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- Australian semaglutide cost: A$4,175/year with ICER of A$96,055/QALY
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- Australian cost-effectiveness threshold: A$50,000/QALY
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- US cost-effectiveness threshold used: $150,000/QALY
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- Study funded by Novo Nordisk with 48% rebate assumption
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