extract: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd
Pentagon-Agent: Ganymede <F99EBFA6-547B-4096-BEEA-1D59C3E4028A>
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Teleo Agents
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@ -47,6 +47,12 @@ MASH/NASH is projected to become the leading cause of liver transplantation. GLP
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The BALANCE Model directly addresses the chronic use inflation problem by requiring lifestyle interventions alongside medication. If lifestyle supports can sustain metabolic benefits after medication discontinuation, the model could demonstrate a pathway to positive net cost impact. The 6-year test window (through 2031) will provide empirical data on whether combined intervention changes the chronic use economics.
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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 achieves $32,219/QALY at rebated prices (48% discount), making it highly cost-effective. With Medicare negotiated prices at $245/month (82% below list), the intervention likely becomes cost-saving within 5-10 years rather than remaining inflationary through 2035. The price trajectory matters more than the chronic use model for net cost impact.
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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 lifetime modeling quantifies the relative economic contribution of each protection mechanism: T2D prevention ($14,431/subject) >> CKD prevention ($2,074) >> CV event prevention ($1,512). The compounding value exists but is dominated by metabolic disease prevention, not cardiovascular protection.
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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": "glp-1-cost-effectiveness-is-price-dependent-with-rebated-prices-achieving-32k-per-qaly-versus-136k-at-list-price.md",
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"issues": [
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"missing_attribution_extractor"
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{
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"filename": "glp-1-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-making-metabolic-disease-prevention-the-primary-economic-mechanism.md",
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"issues": [
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"missing_attribution_extractor"
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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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],
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"rejections": [
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},
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"model": "anthropic/claude-sonnet-4.5",
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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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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"]
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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 +47,10 @@ 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 per 100,000 subjects treated (lifetime): 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 semaglutide treatment cost: $47,353
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- Australian semaglutide cost-effectiveness threshold: A$50,000/QALY (not met at A$96,055/QALY)
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- ICER 2025 assessment: semaglutide would need 80% price reduction to meet standard threshold at list price
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