Cost-effectiveness analysis of oral semaglutide versus subcutaneous dulaglutide in patients with type 2 diabetes mellitus: A Markov model study.

AIM: This study assessed the cost-effectiveness of oral semaglutide versus subcutaneous dulaglutide for type 2 diabetes mellitus (T2DM) from the perspective of the Taiwanese healthcare payer, considering the self-paid status of oral semaglutide and the reimbursed but injectable route of dulaglutide under the National Health Insurance (NHI). METHODS: A Markov decision-analytic model simulated clinical and economic outcomes over a 10-year horizon. Transition probabilities, utilities, and treatment costs were derived from clinical trials, national databases, and expert consensus. Costs and health outcomes were discounted at 3% annually. The willingness-to-pay (WTP) threshold was set at US$33,983, reflecting per capita gross domestic product in Taiwan. Probabilistic and one-way sensitivity analyses evaluated model robustness. RESULTS: Oral semaglutide was dominant, yielding an incremental gain of 0.33 quality-adjusted life years (QALYs) and reducing costs by US$1,137 compared with dulaglutide, with an incremental cost-utility ratio of -US$3,478.66/QALYs. Sensitivity analyses confirmed the robustness, with a 96.5% probability of cost-effectiveness across all WTP thresholds. Cost differences were most sensitive to drug price, particularly in patients without cardiovascular disease. CONCLUSION: Oral semaglutide demonstrated higher clinical effectiveness and strong economic favorability relative to dulaglutide, supporting its potential inclusion in Taiwan NHI formulary to optimize the allocation of healthcare resources in T2DM.