Is semaglutide cost-effective at closing the gap for Aboriginal and Torres Strait Islander Australians with cardiovascular disease and obesity without type 2 diabetes?

BACKGROUND: Aboriginal and Torres Strait Islander Australians experience worse healthcare outcomes due to increased prevalence of cardiovascular disease (CVD). A large proportion of this is preventable if CVD risk factors, such as obesity, are effectively treated. In the SELECT (Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity) trial, the use of semaglutide for patients with CVD and obesity without type 2 diabetes (T2D) significantly reduced the prevalence of CVD. AIM: To determine the cost-benefit to the Australian healthcare system of funding early-access semaglutide for treating Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D. METHODS: A Markov cohort state-transition model was annually cycled for 25 years. The population was Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D. They received either semaglutide or standard care. Transition probabilities, utilities, costs and discounting were literature-derived. The incremental cost-effectiveness ratio (ICER) was our primary outcome. Disability-adjusted life-years (DALYs) and fatal and non-fatal CVD events prevented were secondary outcomes. Sensitivity analysis for various scenarios was performed. RESULTS: In the estimated 13 650 Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D, semaglutide was modelled to prevent an additional 929 fatal CVD events, 13 480 non-fatal CVD events and 8628 DALYs over 25 years at an additional cost to the Australian government of $25 956 522/year (<0.2% of annual CVD expenditure). The ICER was $75 206/DALYs. CONCLUSION: A strategy of early-access funding and use of semaglutide for Aboriginal and Torres Strait Islander Australians with CVD and obesity without T2D may be cost-effective to the Australian healthcare system while closing the gap in healthcare disparities.