Abstract Background The SELECT trial demonstrated that semaglutide 2.4 mg once weekly significantly reduced the risk of major adverse cardiovascular events (MACE; hazard ratio: 0.80; 95% confidence interval CI: 0.72, 0.90; p0.0001) vs standard of care (SoC) for management of cardiovascular diseases (CVD) in people with body mass index (BMI) ≥ 27 without diabetes.1 To date, no evidence is available on the potential value of semaglutide for secondary CVD prevention in people with BMI≥27 in the UK at national level. Purpose To assess the potential value of semaglutide for secondary CVD prevention in the UK in a population of people with established CVD (eCVD) and BMI≥27. Methods A 2008-2021 cohort was obtained from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (average follow-up: 8.4 years) by applying recruitment criteria aligned with the SELECT trial. An economic model (Figure 1) was used to extrapolate the impact of semaglutide up to 15 years using parametric survival curves derived from SELECT, calibrated toward CPRD event rates, assuming the same semaglutide relative treatment effect as that observed in the SELECT trial.1-4 National-level projections were calculated by assuming that the UK prevalence of people with BMI≥27 without diabetes could be applied to the UK population with eCVD and that they would reflect event rates observed in CPRD.5,6 The healthcare costs were calculated using the NHS perspective. Results The CPRD cohort meeting the SELECT recruitment criteria was 10 years older and had a 10% higher proportion of females. The model successfully predicted the number of events for subjects on SoC in both cohorts (SELECT: Figure 2, panels a; CPRD: Figure 2, panel b) and the number of events prevented in the SELECT trial (Figure 2, panels c). If deployed nationally in the UK for 15 years, semaglutide was predicted to provide an additional 1.6 million life years (95% CI: 0.4 – 2.7 million) by preventing 0.9 million CVD events (95% CI: 0.4 – 1.2 million) (Figure 2, panel d), leading to a saving of approximately £2.5 billion (95% CI: 1.2 – 4.2 billion), half of which is due to MACEs avoided. Reduced progression in kidney disease and (pre-)diabetes suggested in SELECT could save an additional £7.0 billion (95%CI: 2.0 – 12.1 billion).7,8 Conclusions Semaglutide is projected to extend life expectancy in people with eCVD and BMI≥27 in the UK by preventing 0.4 million of MACEs, which may require hospitalisations. Our analysis may have potentially underestimated the true impact of semaglutide, as freeing up scarce resources like hospital beds could have prevented even more fatal events resulting from delays in accessing emergency care and hospital beds, which were recently associated with 14,000 excess deaths per year in the UK.9 Further research is needed to more thoroughly explore the potential impact of semaglutide in the real world and to fully account for differences in populations.Figure 1.Model schematics Figure 2.SELECT and CPRD events
Fusco et al. (Sat,) studied this question.