Table 3.
Sensitivity analyses results
| Analysis | Oral semaglutide 14 mg vs. empagliflozin 25 mg (PIONEER 2) | Oral semaglutide 14 mg vs. sitagliptin 100 mg (PIONEER 3) | Oral semaglutide 14 mg vs. liraglutide 1.8 mg (PIONEER 4) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Δ Discounted QALE (QALYs) | Δ Discounted direct costs (GBP) | ICER (GBP per QALY gained) | Δ Discounted QALE (QALYs) | Δ Discounted direct costs (GBP) | ICER (GBP per QALY gained) | Δ Discounted QALE (QALYs) | Δ Discounted direct costs (GBP) | ICER (GBP per QALY gained)a | |
| Base case | + 0.09 | + 971 | 11,006 | + 0.20 | + 963 | 4930 | + 0.07 | − 1551 | Oral semaglutide dominant |
| Statistically significant differences only | + 0.08 | + 973 | 11,605 | + 0.19 | + 960 | 5048 | + 0.06 | − 1572 | Oral semaglutide dominant |
| 35-year time horizon | + 0.09 | + 1074 | 11,572 | + 0.19 | + 855 | 4532 | + 0.07 | − 1473 | Oral semaglutide dominant |
| 20-year time horizon | + 0.08 | + 999 | 12,924 | + 0.15 | + 811 | 5438 | + 0.03 | − 1492 | Oral semaglutide dominant |
| 10-year time horizon | + 0.05 | + 1176 | 21,821 | + 0.09 | + 1060 | 11,232 | + 0.03 | − 1492 | Oral semaglutide dominant |
| 0% Discount rates | + 0.14 | + 906 | 6693 | + 0.32 | + 1049 | 3333 | + 0.12 | − 1646 | Oral semaglutide dominant |
| 6% Discount rates | + 0.07 | + 988 | 14,182 | + 0.15 | + 954 | 6315 | + 0.05 | − 1467 | Oral semaglutide dominant |
| Upper 95% CI of HbA1c ETD | + 0.11 | + 828 | 7615 | + 0.14 | + 667 | 4840 | + 0.06 | − 1452 | Oral semaglutide dominant |
| Lower 95% CI of HbA1c ETD | + 0.08 | + 1098 | 13,211 | + 0.20 | + 880 | 4307 | + 0.13 | − 1227 | Oral semaglutide dominant |
| Upper 95% CI of BMI ETD | + 0.10 | + 976 | 9371 | + 0.18 | + 961 | 5278 | + 0.06 | − 1564 | Oral semaglutide dominant |
| Lower 95% CI of BMI ETD | + 0.07 | + 942 | 13,752 | + 0.20 | + 985 | 4846 | + 0.08 | − 1529 | Oral semaglutide dominant |
| BMI difference maintained for patient lifetimes | + 0.12 | + 978 | 8257 | + 0.25 | + 971 | 3817 | + 0.07 | − 1562 | Oral semaglutide dominant |
| Treatment switching at 7.0% HbA1c | + 0.11 | + 557 | 5232 | + 0.11 | + 168 | 1514 | + 0.09 | − 305 | Oral semaglutide dominant |
| Treatment switching at 8.0% HbA1c | + 0.10 | + 1726 | 17,545 | + 0.19 | + 1333 | 6977 | + 0.07 | − 2387 | Oral semaglutide dominant |
| Second treatment intensification at 7.5% HbA1c to basal–bolus | + 0.15 | + 654 | 4316 | + 0.27 | + 210 | 779 | + 0.07 | − 1420 | Oral semaglutide dominant |
| NPH basal insulin cost applied | + 0.09 | + 1111 | 12,600 | + 0.20 | + 1237 | 6334 | + 0.07 | − 1562 | Oral semaglutide dominant |
| Lantus cost applied | + 0.09 | + 1082 | 12,267 | + 0.20 | + 1054 | 5397 | + 0.07 | − 1418 | Oral semaglutide dominant |
| Semglee cost applied | + 0.09 | + 1013 | 11,480 | + 0.20 | + 1044 | 5348 | + 0.07 | − 1554 | Oral semaglutide dominant |
| Oral semaglutide price + 5% | + 0.09 | + 1102 | 12,490 | + 0.20 | + 1092 | 5594 | + 0.07 | − 1420 | Oral semaglutide dominant |
| Oral semaglutide price − 5% | + 0.09 | + 840 | 9522 | + 0.20 | + 833 | 4266 | + 0.07 | − 1681 | Oral semaglutide dominant |
| Liraglutide 1.2 mg price applied | – | – | – | – | – | – | + 0.07 | − 246 | Oral semaglutide dominant |
| Cost of complications + 10% | + 0.09 | + 933 | 10,583 | + 0.20 | + 915 | 4687 | + 0.07 | − 1570 | Oral semaglutide dominant |
| Cost of complications − 10% | + 0.09 | + 1011 | 11,467 | + 0.20 | + 1017 | 5206 | + 0.07 | − 1531 | Oral semaglutide dominant |
| Alternative costs of stroke applied | + 0.09 | + 968 | 10,973 | + 0.20 | + 946 | 4846 | + 0.07 | − 1551 | Oral semaglutide dominant |
| UKPDS 82 risk equations applied | + 0.07 | + 1026 | 14,041 | + 0.14 | + 806 | 5671 | + 0.03 | − 1520 | Oral semaglutide dominant |
| Lee et al. [26] BMI disutility applied | + 0.10 | + 971 | 10,219 | + 0.20 | + 963 | 4729 | + 0.07 | − 1551 | Oral semaglutide dominant |
| Diminishing hypoglycaemia disutility model | + 0.09 | + 971 | 10,920 | + 0.20 | + 963 | 4922 | + 0.07 | − 1551 | Oral semaglutide dominant |
| Currie et al. [44] hypoglycaemia disutilities | + 0.08 | + 971 | 12,195 | + 0.18 | + 963 | 5409 | + 0.07 | − 1551 | Oral semaglutide dominant |
| 26-week treatment effects applied | + 0.07 | + 1079 | 15,413 | + 0.15 | + 872 | 5874 | + 0.08 | − 1108 | Oral semaglutide dominant |
| Treatment policy estimand | + 0.06 | + 722 | 12,274 | + 0.12 | + 584 | 4704 | + 0.05 | − 1356 | Oral semaglutide dominant |
CI Confidence interval, Δ difference in, ETD estimated treatment difference, NPH neutral protamine Hagedorn, UKPDS United Kingdom Prospective Diabetes Study
aDominant indicates that the intervention is associated with improved clinical outcomes and cost savings