Risk stratification using coronary artery calcium and potential benefit of semaglutide therapy: A cost‐effectiveness modelling study

Abstract Aim Coronary artery calcium (CAC) scoring is observed to improve risk stratification for major adverse cardiovascular events (MACE). Semaglutide, a recently introduced anti‐obesity drug, is very effective, but wider use is limited due to high costs. Hence, this study investigated the cost‐effectiveness (CEA) of semaglutide across CAC groups. Materials and Methods CAC scores for 38 058 CLARIFY registry participants meeting SELECT criteria were included. They were stratified into four CAC groups: 0, 1–99, 100–399, ≥400. To determine MACE (composite of myocardial infarction, heart failure, stroke or all‐cause mortality) risk across CAC groups, hazard ratios (HR) were estimated from multi‐variable adjusted Cox proportional hazard models. Next, lifetime‐horizon Markov models were created to simulate semaglutide therapy and the potential clinical benefit (reported as number needed to treat NNT) and CEA (estimated with incremental cost‐effectiveness ratio ICER) were examined for CAC groups. Multiple scenarios to mimic real‐world experience were fitted for robust sensitivity analyses. Results Compared to CAC = 0, MACE risk was higher for CAC ≥400 (HR: 1. 97 95% CI: 1. 66–2. 35), heart failure (HR: 1. 76 95% CI: 1. 36–2. 28), mortality (HR: 1. 62 95% CI: 1. 21–2. 17). Modelling 3. 3 years of semaglutide use resulted in potential MACE NNT values of 151 (95% CI: 108–302) and 34 (95% CI: 25–69) for CAC = 0 and CAC ≥400. Markov modelled ICER for semaglutide use reduced across CAC groups (625 863/QALY CAC = 0 vs. 168 666/QALY CAC ≥400). Conclusions CAC scores have potential use as a tool to estimate potential clinical benefit and cost for lifetime semaglutide therapy among obese individuals.