A structured health technology assessment ranked semaglutide and dulaglutide as the top once-weekly GLP-1 receptor agonists for Chinese hospitals based on efficacy, cardiovascular benefits, and cost.
Semaglutide: 77.8 out of 100Semaglutide achieved the highest score across five evaluation dimensions, driven by superior efficacy and cardiovascular benefit, earning a 'strongly recommended' classification.
What the researchers found
Semaglutide (score: 77.8) and dulaglutide (76.3) ranked highest among four once-weekly GLP-1 RAs, driven by superior HbA1c reduction and proven cardiovascular benefit. Both received "strongly recommended" classification. Exenatide microspheres (70.2) was also strongly recommended, primarily due to favorable cost. PEG loxenatide (62.9) received a weak recommendation due to narrower reimbursement and lower international adoption. Safety profiles were comparable across all four agents.
Why it matters
As GLP-1 peptide drugs become increasingly central to diabetes management globally, hospitals and health systems need rational frameworks for choosing among them. This study provides a replicable method for head-to-head comparison that goes beyond simple efficacy to include cost, policy, and practical factors — particularly relevant in markets like China where drug pricing negotiations affect availability.
How the study worked
Three-stage structured mini-health technology assessment (mini-HTA). Stage 1: Expert consensus established weighted scoring across five dimensions (pharmaceutical properties, effectiveness, safety, economy, other). Stage 2: PICO-based systematic evidence collection from guidelines, literature, and official documents. Stage 3: Quantitative scoring of each drug with classification into recommendation levels based on total scores.
What this study cannot tell us
Expert consensus-based weights introduce subjectivity into the scoring system. The assessment was designed for the Chinese healthcare context, and recommendations may not apply in other regulatory and reimbursement environments. PEG loxenatide's lower score partly reflects limited international adoption rather than inherent drug deficiencies. The framework does not account for individual patient characteristics that might favor one agent over another.
How to read the evidence
This is a health technology assessment using expert consensus and systematic evidence review. While it provides a structured evaluation framework, the weighted scoring involves subjective elements and the final rankings depend on the chosen weights.
When this study was published
Published in 2025, this assessment reflects the current landscape of once-weekly GLP-1 receptor agonists available in China.
The bigger picture
The rapid expansion of GLP-1 peptide drugs has created a challenge for healthcare systems worldwide: how to choose between multiple similar agents. This study applies health technology assessment methodology to the GLP-1 class specifically, producing actionable rankings. As more GLP-1 drugs enter the market (including oral formulations and dual/triple agonists), structured comparison frameworks like this will become essential for rational prescribing and formulary decisions.
Questions still open
- Would the rankings change if weight loss efficacy were weighted more heavily alongside glycemic control?
- How would newer oral GLP-1 formulations score in this framework?
- Could this mini-HTA approach be standardized across countries to enable international GLP-1 drug comparisons?
Common questions
Why does the ranking differ from what I might hear about GLP-1 drugs in the US?
What made semaglutide score highest among the GLP-1 drugs?
Read the original research
Digital multicriteria evaluation of negotiated medicines using Chinese mini-HTA: application of structured methodologies in assessing once-weekly GLP-1 RAs for improved clinical decision-making.
Frontiers in pharmacology, 16, 1588056
Citation
Li, Xiao; Qiu, Zhihong; Xue, Chaojun; Ren, Xiaokai; Dong, Zhanjun. (2025). Digital multicriteria evaluation of negotiated medicines using Chinese mini-HTA: application of structured methodologies in assessing once-weekly GLP-1 RAs for improved clinical decision-making.. Frontiers in pharmacology, 16, 1588056. https://doi.org/10.3389/fphar.2025.1588056