Adding semaglutide to usual care for secondary prevention of CVD in US adults without diabetes is projected to avert 358,400 MACE at a cost of $148,100 per QALY gained.
Cohort (n=4,000,000)
Does lifetime treatment with weekly subcutaneous semaglutide added to usual care improve cost-effectiveness and reduce MACE in US adults age 45 years or older with overweight or obesity and history of MI or stroke without diabetes?
Semaglutide for secondary prevention of CVD in US adults with overweight or obesity without diabetes yields meaningful health benefits but requires an 18% price reduction to be cost-effective at a $120,000/QALY threshold.
Effect estimate: ICER $148 100 per QALY gained (95% CI $127 100-$173 400)
Importance Semaglutide reduces the risk of major adverse cardiovascular events (MACE) in adults with overweight or obesity and cardiovascular disease (CVD) but without diabetes. The cost-effectiveness and budget impact of semaglutide therapy could inform ongoing Medicare price negotiations but are uncertain. Objective To evaluate the cost-effectiveness of semaglutide for secondary prevention of CVD and potential effect on US health care spending. Design, Setting, and Participants This population-based cohort simulation study used the CVD Policy Model, a validated simulation model of CVD outcomes and costs in the US, to evaluate lifetime cost-effectiveness of semaglutide. The addition of lifetime treatment with weekly subcutaneous semaglutide to usual care compared with usual care alone in US adults age 45 years or older, with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or higher, and history of myocardial infarction or stroke, without diabetes were evaluated. The model incorporated annual semaglutide cost of 8604 (2023 US price net of rebates and discounts) and adopted a health-system perspective. Sensitivity analyses explored uncertainty. These data were analyzed from January 2024 and June 2025. Exposure Semaglutide and usual care compared with usual care alone. Main Outcomes and Measures Main outcomes were lifetime MACE (cardiovascular death, myocardial infarction, or stroke), incremental cost per quality-adjusted life-year (QALY), and change in annual US health care spending. Results Adding semaglutide to usual care in the estimated 4 million US adults without diabetes eligible for secondary prevention of CVD is projected to avert 358 400 MACE at a cost of 148 100 per QALY gained (95% uncertainty interval, 127 100-173 400). The mean age of this cohort was 66 years and 55% were male and 45% were female. Treatment with semaglutide was projected to increase annual health care spending by 23 billion. Semaglutide would be cost-effective at a threshold of 120 000 per QALY gained if the annual cost were lowered an additional 18% to 7055. Semaglutide is cost-effective for this indication at the cash price currently available to self-paying customers (5988; incremental cost-effectiveness ratio, 99 600 per QALY gained). Conclusions and Relevance Semaglutide for secondary prevention of CVD in US adults with overweight or obesity but without diabetes is projected to yield meaningful health benefits. Lowering annual drug costs by 18% from 8604 to 7055—or making the current cash price available to all patients—would make semaglutide cost-effective at 120 000 per QALY gained.
Hennessy et al. (Wed,) conducted a cohort in Overweight or obesity and cardiovascular disease without diabetes (n=4,000,000). Semaglutide vs. Usual care alone was evaluated on Lifetime MACE (cardiovascular death, myocardial infarction, or stroke), incremental cost per quality-adjusted life-year (QALY), and change in annual US health care spending (ICER $148 100 per QALY gained, 95% CI $127 100-$173 400). Adding semaglutide to usual care for secondary prevention of CVD in US adults without diabetes is projected to avert 358,400 MACE at a cost of $148,100 per QALY gained.