extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd
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@ -41,6 +41,12 @@ MA plans' near-universal prior authorization creates administrative friction tha
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MASH/NASH is projected to become the leading cause of liver transplantation. GLP-1s now demonstrate efficacy across three major organ systems (cardiovascular, renal, hepatic), which strengthens the multi-indication economic case for chronic use. The 62.9% MASH resolution rate suggests GLP-1s could prevent progression to late-stage liver disease and transplantation, though the Value in Health Medicare study showed only $28M MASH savings—surprisingly small given clinical magnitude, likely because MASH progression to transplant takes decades and falls outside typical budget scoring windows.
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### Additional Evidence (challenge)
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*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16*
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SELECT trial cost-effectiveness analysis shows semaglutide ICER of $32,219/QALY at net prices (48% rebate) versus $136,271/QALY at list prices. At Medicare negotiated price of $245/month, GLP-1s likely cross into cost-saving territory, challenging the 'inflationary through 2035' timeline. The price trajectory (declining) may flip the cost-effectiveness conclusion faster than 2035.
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---
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Relevant Notes:
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@ -42,6 +42,12 @@ SELECT trial exploratory analysis (N=17,604, median 41.8 months) shows semagluti
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Phase 3 trial shows semaglutide 2.4mg achieves 62.9% resolution of steatohepatitis without worsening fibrosis vs 34.3% placebo. Meta-analysis confirms GLP-1 RAs significantly increase histologic resolution of MASH, decrease liver fat deposition, improve hepatocellular ballooning, and reduce lobular inflammation. Some hepatoprotective benefits appear at least partly independent of weight loss, suggesting direct liver effects beyond metabolic improvement. This adds hepatic protection as a third major organ system (alongside cardiovascular and renal) where GLP-1s demonstrate protective effects.
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### Additional Evidence (extend)
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*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-16*
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SELECT trial quantifies the economic hierarchy of multi-organ protection: T2D prevention ($14,431/subject) >> CKD prevention ($2,074) > CV event prevention ($1,512). The compounding value is real but heavily weighted toward metabolic endpoints.
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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: 2026-03-16*
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SELECT trial economic modeling shows per-subject lifetime savings from avoided T2D ($14,431) exceed CKD savings ($2,074) by 7x and CV event savings ($1,512) by 9.5x. Diabetes prevention, not kidney protection, may be the largest per-patient economic benefit.
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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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"issues": [
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"validation_stats": {
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"rejections": [
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"date": "2026-03-16"
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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: 2026-03-16
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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 +47,11 @@ 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 modeled 100,000 subjects over 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: $47,353
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- Australian analysis: semaglutide at A$4,175/year yields ICER of A$96,055/QALY, not cost-effective at A$50,000/QALY threshold
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- ICER 2025 assessment: semaglutide and tirzepatide now meet <$100K/QALY at net prices (shift from 2022 assessment)
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- Study funded by Novo Nordisk; 48% rebate estimate is industry assumption of net pricing
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