Diabetes therapy : research, treatment and education of diabetes and related disordersDec 12, 2018

Comparing Weekly Semaglutide and Daily Liraglutide for Long-Term Cost-Effectiveness in Treating Type 2 Diabetes in Estonia

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Updated Apr 6, 2026

Abstract

Once-weekly semaglutide 1 mg was associated with an improvement of 0.13 quality-adjusted life years (QALYs) compared to liraglutide 1.2 mg.

Once-weekly semaglutide resulted in higher direct costs by EUR 67 due to its acquisition cost.
Cost savings from avoiding diabetes-related complications largely offset the increased costs associated with semaglutide.
The incremental cost-effectiveness ratio for once-weekly semaglutide was EUR 523 per gained.
This cost-effectiveness ratio is significantly below the willingness-to-pay threshold of EUR 52,390 per QALY gained in Estonia.

Simplified

INTRODUCTION: Once-weekly semaglutide is a novel glucagon-like peptide-1 (GLP-1) analogue for the treatment of type 2 diabetes that was associated with greater reductions in glycated hemoglobin (HbA1c) and body mass index (BMI) versus once-daily GLP-1 analogue liraglutide in a recent network meta-analysis (NMA). The aim of the present study was to assess the long-term cost-effectiveness of once-weekly semaglutide 1 mg versus liraglutide 1.2 mg in Estonia.

METHODS: Outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model (version 9.0), with baseline cohort characteristics sourced from SUSTAIN 3 and changes in HbA1c, systolic blood pressure (SBP), and BMI associated with once-weekly semaglutide and liraglutide derived from the NMA. Patients were assumed to receive once-weekly semaglutide or liraglutide for 5 years before intensifying to basal insulin. Treatment effects were applied for the first 5 years, after which HbA1c increased to 7.0%, SBP followed a natural progression, and BMI reverted to baseline for the remainder of the analysis. Costs were expressed in euros (EUR) and estimated from a healthcare payer perspective. Utilities associated with diabetes and diabetes-related complications were taken from published sources.

RESULTS: Once-weekly semaglutide 1 mg was associated with improvements in quality-adjusted life expectancy of 0.13 quality-adjusted life years (QALYs) versus liraglutide 1.2 mg. Direct costs were EUR 67 higher with once-weekly semaglutide, due to the increased acquisition cost, but this was mostly offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 1 mg was therefore associated with an incremental cost-effectiveness ratio of EUR 523 per gained versus liraglutide 1.2 mg, which falls well below a willingness-to-pay threshold of EUR 52,390 per QALY gained (three times the Estonian GDP per capita).

CONCLUSION: Once-weekly semaglutide was considered highly cost-effective versus liraglutide 1.2 mg for the treatment of patients with type 2 diabetes in Estonia.

FUNDING: Novo Nordisk A/S. Plain language summary available for this article.

Key numbers

0.13 QALYs

Quality-Adjusted Life Expectancy Improvement

Improvement with once-weekly semaglutide 1 mg vs. liraglutide 1.2 mg

EUR 523 per gained

Incremental Cost-Effectiveness Ratio

Cost-effectiveness of semaglutide compared to liraglutide

EUR 67

Direct Cost Difference

Higher costs associated with once-weekly semaglutide vs. liraglutide

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Comparing Weekly Semaglutide and Daily Liraglutide for Long-Term Cost-Effectiveness in Treating Type 2 Diabetes in Estonia

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