Could Semaglutide Be Cost-Effective for Reducing Heart Disease in Indigenous Australians with Obesity?

What the researchers found

In a 25-year Markov model of 13,650 Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity (without type 2 diabetes), semaglutide was projected to prevent 929 additional fatal CVD events and 13,480 non-fatal CVD events compared to standard care. The program would save 8,628 disability-adjusted life years at an additional cost of approximately $26 million per year to the Australian government — less than 0.2% of annual CVD expenditure. The incremental cost-effectiveness ratio was $75,206/DALY.

Why it matters

Indigenous Australians experience a disproportionate burden of cardiovascular disease that is largely preventable. This study provides health-economic evidence that could support policy decisions to fund semaglutide for this underserved population, potentially addressing a significant health equity gap at a cost that falls within acceptable thresholds.

How the study worked

The researchers built a Markov cohort state-transition model that cycled annually over 25 years. The target population was Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity without type 2 diabetes, receiving either semaglutide or standard care. Transition probabilities, utilities, costs, and discount rates were derived from published literature including the SELECT trial. Sensitivity analyses tested various scenarios.

What this study cannot tell us

This is a modeling study, not a clinical trial, so results depend on assumptions about transition probabilities and costs. The SELECT trial population may not perfectly represent Indigenous Australians. The model assumes full adherence to semaglutide over 25 years, which is unrealistic in practice. Cultural and access barriers to medication use in remote communities were not modeled. Drug pricing may change over time.

How to read the evidence

This is a cost-effectiveness modeling study based on published trial data (SELECT) and literature-derived parameters. While it provides useful health-economic projections, these are simulated outcomes, not observed clinical results in the target population.

When this study was published

Published in 2025, this is a timely analysis responding to the recent approval of semaglutide for cardiovascular risk reduction, making it directly relevant to current policy discussions.

The bigger picture

This study sits at the intersection of precision pharmacotherapy and health equity. As GLP-1 drugs prove effective for cardiovascular risk reduction beyond diabetes, the question of who gets access — and whether healthcare systems can justify the cost for underserved populations — becomes a critical policy issue worldwide, not just in Australia.

Questions still open

• What are the real-world barriers to semaglutide access and adherence in remote Indigenous Australian communities?
• Would similar cost-effectiveness results apply to other underserved populations globally?
• How would reduced drug prices or biosimilar competition change the cost-effectiveness calculation?

Common questions

Read the original research

Is semaglutide cost-effective at closing the gap for Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity without type 2 diabetes?

Internal medicine journal, 55(10), 1725-1732

Citation

Hargovan, Satyen; Hunt, Nadine; Kostakis, Hara; Chow, Clara K. (2025). Is semaglutide cost-effective at closing the gap for Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity without type 2 diabetes?. Internal medicine journal, 55(10), 1725-1732. https://doi.org/10.1111/imj.70160