HMN 2026: How Semaglutide improves cardiovascular health but price reductions are needed to make it cost-effective

Semaglutide, the active ingredient in the weight-loss medications Ozempic and Wegovy, offers substantial cardiovascular benefits for selected patients without diabetes who have established heart disease, but further price reductions are needed to make the therapy good value for money, according to a new analysis from researchers at Beth Israel Deaconess Medical Center (BIDMC).

The study, published in JAMA Cardiology, focused on the approximately 4 million United States adults without diabetes who have overweight or obesity and established cardiovascular disease. It found that lifetime treatment of this high-risk population with semaglutide would avert more than 358,000 heart attacks, strokes, and cardiovascular deaths.

Preventing those events is estimated to save nearly $15 billion in health care spending for cardiovascular care and $8 billion in spending for other care. But the drug itself would cost $344 billion over those same lifetimes, meaning the health care savings would offset only a fraction of the increased pharmaceutical spending.

“To our knowledge, this is the first study to systematically examine the value of lifelong semaglutide for preventing heart attacks and strokes in United States adults with established cardiovascular disease,” said senior author Dhruv S. Kazi, MD, MSc, MS, associate director of the Richard A. and Susan F. Smith Center for Outcomes Research and medical director of the Cardiac Critical Care Unit at BIDMC. “The health benefits are real, but we shouldn’t expect them to offset the cost of the drug—semaglutide saves lives, but it won’t save money.”

Health economists use a standard benchmark to evaluate whether a therapy is worth its cost: the incremental cost for each quality-adjusted life-year, or QALY, gained. By using QALYs, economists account for both length and quality of life gained. This study assumed that semaglutide would cost $8,604 per year, which was the 2023 net price—the price insurers actually pay after rebates—not the list price of approximately $14,700.

Even after accounting for these rebates and discounts, semaglutide costs $148,100 per QALY gained, exceeding the $120,000 threshold widely accepted as cost-effective. A further price reduction from $8,604 to $7,055 annually would bring semaglutide within the cost-effective range.

The study incorporated the findings of the landmark SELECT trial into the Cardiovascular Disease Policy Model, an established simulation model of cardiovascular disease in United States adults used to project lifetime health outcomes and costs. The work was conducted with first author Susan Hennessy, Ph.D., MHSc, and colleagues at the University of California, San Francisco.

These findings have important policy implications. Although semaglutide was not found to be cost-effective in this study, there have been several encouraging developments on this front. The manufacturer has announced a substantial price reduction for patients paying for the therapy directly as well as for Medicare beneficiaries. Kazi’s research group has previously used cost-effectiveness analyses to inform cardiovascular drug pricing. A series of analyses of PCSK9 inhibitors published in JAMA beginning in 2016 helped motivate a 60% reduction in those drugs’ annual costs, resulting in an estimated $800 million in annual savings for Medicare.

“Semaglutide and other high-potency GLP-1 agonists are once-in-a-generation breakthroughs that have the potential to transform the cardiometabolic health of the United States population,” Kazi said. “We must ensure that they are affordable and accessible to all patients who can benefit from them, ideally at a price that reflects the value they generate for our health system and society at large.”

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