Cost-effectiveness analysis of Oral Semaglutide treatment for type 2 diabetes mellitus patients: a systematic review

GLP-1 is a new generation of antidiabetics recommended by the American Diabetes Association and European Association for the study of diabetes as an add-on therapy for metformin when therapeutic purposes are not achieved. In this context, oral Semaglutide received FDA approval in September 2019 to be used alongside dietary and exercise regimens to enhance glycemic management in adults diagnosed with type 2 diabetes mellitus (T2DM). Therefore, this systematic review aimed to analyze cost-effectiveness of oral Semaglutide compared to other antidiabetics and/or injectable GLP-1 within the same group. Three databases namely Scopus, ScienceDirect, and PubMed were used for the literature search. Preferred Reporting Items for Systematic Review (PRISMA) guidelines were used to select the studies based on the inclusion and exclusion criteria. Quality assessment was carried out using CHEERS 2022, while the decision on cost-effectiveness was determined using the willingness-to-pay thresholds stated in each study. The results showed that from the initial search yielding 240 studies, 12 met the inclusion criteria. Oral Semaglutide was considered cost-effective compared to SGLT2 and DPP4 inhibitors, as well as injectable GLP-1 due to its higher effectiveness and lower cost. However, it was not cost-effective compared to biguanide/conventional therapy due to the higher cost. The primary sources of uncertainty in the studies were identified as time horizon, discount rate, cost, and treatment policy estimand. In conclusion, the development of oral Semaglutide represents a significant advancement in antidiabetic medications. This systematic review showed that oral Semaglutide appeared to be more cost-effective compared to other antidiabetic medications for T2DM.