Semaglutide 2.4 mg Shows Favorable Cost-Effectiveness Among Patients With MASH
Key Takeaways:
- Among patients with non-cirrhotic metabolic dysfunction‐associated steatohepatitis (MASH) with moderate to advanced fibrosis, semaglutide 2.4 mg yielded more quality-adjusted life-years (QALYs) compared to resmetirom and standard of care (SoC).
- Semaglutide 2.4 mg resulted in an incremental cost-effectiveness ratio (ICER) of $19 911 per QALY gained, which was mainly influenced by slowed disease progression.
- In a probabilistic sensitivity analysis (PSA), semaglutide 2.4 mg consistently demonstrated cost-effectiveness at commonly accepted willingness-to-pay (WTP) thresholds.
The substantial economic burden associated with MASH highlights the need for effective treatment options and improved disease management.
The pharmacotherapies semaglutide and resmetirom have been approved by the US Food and Drug Administration (FDA) to treat patients with non-cirrhotic MASH and moderate to advanced fibrosis. In clinical trials, both therapies demonstrated significant improvements in health outcomes, but few studies have assessed their financial impact on patients and payers.
Study Methods and Outcomes
Researchers used a Makov model to compare the cost-effectiveness of semaglutide 2.4 mg, resmetirom 80 mg and 100 mg, and SoC among patients with non-cirrhotic MASH and moderate to advanced fibrosis.
Outcomes were analyzed over a lifetime horizon and included LYs, QALYs, ICERs, and clinical outcomes.
Costs were based on 2025 US prices, and ICERs were evaluated at WTP thresholds of $50 000, $100 000, and $150 000 per QALY gained.
Cost-Effectiveness of Semaglutide and Resmetirom
Compared to SoC, semaglutide 2.4 mg resulted in an increase of 1.66 QALYs and $33 031 in total costs, yielding an ICER of $19 911 per QALY gained. The QALY gains associated with semaglutide 2.4 mg were primarily driven by slowed disease progression; patients spent more time in earlier fibrosis stages and less time with advanced liver disease.
Resmetirom 80 mg and 100 mg increased QALYs by 1.20 and 1.24 and incremental costs by $415 110 and $245 991, respectively. This resulted in ICERs of $346 810 and $198 607, respectively.
In a PSA, semaglutide 2.4 mg was cost-effective in 99.5% of simulations at the WTP threshold of $150 000 per QALY gained. At WTP thresholds of $50 000 and $100 000, semaglutide 2.4 mg was cost-effective in 71.8% and 84.6% of iterations, respectively.
At WTP thresholds of $50 000, $100 000, and $150 000 per QALY gained, resmetirom 80 mg was cost-effective in 0.0%, 0.0%, and 0.5% of iterations, respectively. Resmetirom 100 mg was cost-effective in 0.1%, 2.5%, and 18.2% of iterations, respectively.
Implications for Managed Care
These findings indicate semaglutide 2.4 mg as a promising therapy option for patients with non-cirrhotic MASH with moderate to advanced fibrosis. It demonstrated meaningful clinical benefits compared to SoC with incremental costs below commonly accepted WTP thresholds.
The upfront drug costs of semaglutide 2.4 mg may be offset by its associated improved disease management, potentially reducing overall total costs and decreasing health care utilization among patients.
Reference
McGovern AJ, Cinfio F, Luo R. A cost-effectiveness model of semaglutide 2.4 mg, resmetirom 80 mg, and resmetirom 100 mg versus standard of care for the treatment of metabolic dysfunction-associated steatohepatitis in the United States. ParmacoEconomics. 2026. doi:10.1007/s40273-026-01647-8
