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 787d6d273..1dba8a3be 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 @@ -29,6 +29,12 @@ Real-world persistence data from 125,474 commercially insured patients shows the The Cell Press review characterizes GLP-1s as marking a 'system-level redefinition' of cardiometabolic management with 'ripple effects across healthcare costs, insurance models, food systems, long-term population health.' Obesity costs the US $400B+ annually, providing context for the scale of potential cost impact. The WHO issued conditional recommendations within 2 years of widespread adoption (December 2025), unusually fast for a major therapeutic category. + +### Additional Evidence (extend) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-15* + +SELECT trial modeling shows semaglutide is highly cost-effective at net prices ($32K/QALY with 48% rebate) but borderline at list prices ($136K/QALY). Recent Medicare deals at $245/month versus $1,350/month list price fundamentally change the cost-effectiveness calculation. The declining price trajectory may flip GLP-1s from inflationary to cost-effective faster than 2035 projection. + --- 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 1222d36b5..e799e1101 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 @@ -30,6 +30,12 @@ For value-based care models and capitated payers, this multi-organ protection cr - Nature Medicine: additive benefits with SGLT2 inhibitors - First GLP-1 to receive FDA indication for CKD in T2D patients + +### Additional Evidence (confirm) +*Source: [[2025-01-01-select-cost-effectiveness-analysis-obesity-cvd]] | Added: 2026-03-15* + +Lifetime modeling quantifies multi-organ savings: $14,431 per subject from avoided T2D, $2,074 from avoided CKD, $1,512 from avoided CV events. Diabetes prevention alone generates 9.6x the economic value of cardiovascular protection, confirming that multi-organ effects compound economic value beyond any single endpoint. + --- 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..397899c33 --- /dev/null +++ b/inbox/archive/.extraction-debug/2025-01-01-select-cost-effectiveness-analysis-obesity-cvd.json @@ -0,0 +1,32 @@ +{ + "rejected_claims": [ + { + "filename": "semaglutide-cost-effectiveness-depends-on-net-price-with-48-percent-rebate-producing-32k-per-qaly-versus-136k-at-list-price.md", + "issues": [ + "missing_attribution_extractor" + ] + }, + { + "filename": "semaglutide-diabetes-prevention-savings-exceed-cardiovascular-savings-by-10x-with-14431-per-subject-from-avoided-t2d-versus-1512-from-cv-events.md", + "issues": [ + "missing_attribution_extractor" + ] + } + ], + "validation_stats": { + "total": 2, + "kept": 0, + "fixed": 2, + "rejected": 2, + "fixes_applied": [ + "semaglutide-cost-effectiveness-depends-on-net-price-with-48-percent-rebate-producing-32k-per-qaly-versus-136k-at-list-price.md:set_created:2026-03-15", + "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" + ], + "rejections": [ + "semaglutide-cost-effectiveness-depends-on-net-price-with-48-percent-rebate-producing-32k-per-qaly-versus-136k-at-list-price.md:missing_attribution_extractor", + "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" + ] + }, + "model": "anthropic/claude-sonnet-4.5", + "date": "2026-03-15" +} \ 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..6e7933305 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: 2026-03-15 +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"] +extraction_model: "anthropic/claude-sonnet-4.5" --- ## Content @@ -43,3 +47,12 @@ 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 cost-effectiveness analysis modeled lifetime outcomes for obese/overweight patients with established CVD but without diabetes +- Per 100,000 subjects treated (lifetime horizon): 2,791 non-fatal MIs avoided, 3,000 revascularizations avoided, 487 strokes avoided, 115 CV deaths avoided +- Average per-subject lifetime treatment cost: $47,353 +- Australian analysis at A$4,175/year yields ICER of A$96,055/QALY (~US$138K/QALY) +- ICER 2025 assessment: semaglutide and tirzepatide now meet <$100K/QALY at net prices (shift from 2022) +- Study was industry-funded by Novo Nordisk with 48% rebate as their assumption of actual net pricing