Key result
Modeled semaglutide yields greater cost-effectiveness at ~$169,000 per QALY for obese patients with CAC ≥400.
Why the study?
Semaglutide is effective for obesity, but wider use is limited by high costs, prompting investigation into its cost-effectiveness across coronary artery calcium risk groups.
Does the cost-effectiveness and clinical benefit of semaglutide vary by coronary artery calcium (CAC) score in individuals meeting SELECT criteria?
Does the cost-effectiveness and clinical benefit of semaglutide vary by coronary artery calcium (CAC) score in individuals meeting SELECT criteria?
Coronary artery calcium scoring can effectively stratify the clinical benefit and cost-effectiveness of semaglutide therapy, with the greatest value seen in patients with CAC ≥400.
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CAC stratification may identify obese patients with greater semaglutide benefit and cost-effectiveness; supports targeted use in high-CAC subgroups for prospective trials.
Aim Coronary artery calcium (CAC) scoring is observed to improve risk stratification for major adverse cardiovascular events (MACE). Semaglutide, a recently introduced anti‐obesity drug, is very effective, but wider use is limited due to high costs. Hence, this study investigated the cost‐effectiveness (CEA) of semaglutide across CAC groups. Materials and Methods CAC scores for 38 058 CLARIFY registry participants meeting SELECT criteria were included. They were stratified into four CAC groups: 0, 1–99, 100–399, ≥400. To determine MACE (composite of myocardial infarction, heart failure, stroke or all‐cause mortality) risk across CAC groups, hazard ratios (HR) were estimated from multi‐variable adjusted Cox proportional hazard models. Next, lifetime‐horizon Markov models were created to simulate semaglutide therapy and the potential clinical benefit (reported as number needed to treat [NNT]) and CEA (estimated with incremental cost‐effectiveness ratio [ICER]) were examined for CAC groups. Multiple scenarios to mimic real‐world experience were fitted for robust sensitivity analyses. Results Compared to CAC = 0, MACE risk was higher for CAC ≥400 (HR: 1.97 [95% CI: 1.66–2.35]), heart failure (HR: 1.76 [95% CI: 1.36–2.28]), mortality (HR: 1.62 [95% CI: 1.21–2.17]). Modelling 3.3 years of semaglutide use resulted in potential MACE NNT values of 151 (95% CI: 108–302) and 34 (95% CI: 25–69) for CAC = 0 and CAC ≥400. Markov modelled ICER for semaglutide use reduced across CAC groups ($625 863/QALY [CAC = 0] vs. $168 666/QALY [CAC ≥400]). Conclusions CAC scores have potential use as a tool to estimate potential clinical benefit and cost for lifetime semaglutide therapy among obese individuals.
Ponnana et al. (2026) studied Obesity (n=38,058). Semaglutide vs. CAC = 0 was evaluated on MACE (composite of myocardial infarction, heart failure, stroke or all-cause mortality) (HR 1.97, 95% CI 1.66-2.35). Modelling semaglutide therapy in obese individuals showed greater clinical benefit and improved cost-effectiveness for those with CAC ≥400 (ICER $168,666/QALY) compared to CAC = 0 ($625,863/QALY).
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