Despite similar UK drug costs, semaglutide got 21–51% more patients to diabetes treatment goals than exenatide ER, liraglutide, and dulaglutide.
21–51% advantagesemaglutide gets significantly more patients to diabetes treatment goals than three competitor GLP-1 drugs at similar UK cost
What the researchers found
Annual per-patient costs were similar across all four GLP-1 receptor agonists in the UK market. However, once-weekly semaglutide consistently outperformed the others in getting patients to treatment goals.
For the composite endpoint of HbA1c below 7.0% without weight gain or low blood sugar episodes, the competing drugs fell short: exenatide ER was 50.0% less effective, liraglutide was 51.3% less effective, and dulaglutide was 21.6% less effective than semaglutide.
Semaglutide also led in single endpoints including HbA1c targets (below 7.0% and below 7.5%) and meaningful weight loss (5% or more body weight reduction).
Why it matters
When multiple drugs in the same class cost about the same, the one that helps the most patients reach their goals offers the best value. This analysis showed semaglutide delivered more clinical benefit per pound spent across every measured outcome.
For healthcare systems making formulary decisions, this type of analysis helps justify choosing one drug over another when prices are similar.
The numbers in context
Exenatide ER 50.0% less effective; liraglutide 51.3% less effective; dulaglutide 21.6% less effective vs semaglutide at composite endpoint
How the study worked
This was a cost-of-control analysis using clinical data from the SUSTAIN trial program. Researchers compared the proportion of patients reaching various treatment targets across the four drugs and divided annual UK drug costs by efficacy rates to calculate cost per responder.
Who was studied
Type 2 diabetes patients from SUSTAIN clinical trial program
What this study cannot tell us
This analysis used data from the SUSTAIN clinical trials, which may not perfectly reflect real-world outcomes. Different patient populations, adherence rates, and healthcare settings could change the results.
Prices were based on July 2019 UK wholesale costs, which may have changed since then.
How to read the evidence
Moderate evidence from cost-of-control analysis based on SUSTAIN clinical trial data. Real-world results may differ.
When this study was published
Published in 2020. Drug costs and clinical evidence have evolved since this analysis.
The bigger picture
When drugs cost the same, the one that works best for more patients delivers the most value. This analysis provides ammunition for formulary inclusion of semaglutide and for patients and clinicians choosing among GLP-1 options.
Questions still open
- Do real-world adherence differences change the cost-effectiveness picture?
- How do these compare when weight loss and cardiovascular outcomes are included?
- Will semaglutide biosimilars change the competitive landscape?
Common questions
If GLP-1 drugs cost the same, which should I choose?
Why compare cost-of-control instead of just drug price?
Read the original research
A Relative Cost of Control Analysis of Once-Weekly Semaglutide Versus Exenatide Extended-Release, Dulaglutide and Liraglutide in the UK.
Advances in therapy, 37(3), 1248-1259
Citation
Johansen, Pierre; Sandberg, Anna; Capehorn, Matthew. (2020). A Relative Cost of Control Analysis of Once-Weekly Semaglutide Versus Exenatide Extended-Release, Dulaglutide and Liraglutide in the UK.. Advances in therapy, 37(3), 1248-1259. https://doi.org/10.1007/s12325-020-01242-z