(1273) Preconception glucagon-like peptide-1 receptor agonist therapy for Type 2 Diabetes Mellitus: A Cost-Effectiveness Analysis

As the rate of type 2 diabetes mellitus (T2DM) among women of reproductive age continues to rise, interest has grown in using preconception glucagon-like peptide-1 receptor agonist (GLP1 RA) therapy to reduce obstetrical morbidity and mortality associated with T2DM. This study aimed to evaluate if preconception GLP1 RA therapy is a cost-effective intervention to improve perinatal outcomes in those with pregnancies complicated by T2DM. 

Study Design:
A TreeAge decision-analytic model was constructed to compare outcomes and effectiveness of one year of GLP-1 RA therapy before conception in a cohort of 43,152 people with T2DM. Our cohort was estimated from the annual number of live births affected by T2DM in the U.S. Outcomes included preeclampsia, preterm birth, neonatal intensive care unit (NICU) admission, neonatal death, and neurodevelopmental delay. The incremental cost-effectiveness ratio (ICER) was set to $100,000 per quality-adjusted life years (QALYs) to compare strategies, accounting for maternal and neonatal utilities.  All model inputs were derived from the literature, and sensitivity analyses were conducted to test the robustness of the results. 

Results:
GLP-1 RA therapy for one year prior to conception resulted in fewer cases of preeclampsia, preterm birth, NICU admissions, neonatal death, and neurodevelopmental delay compared to no GLP-1 RA therapy (Table 1).  Although preconception GLP-1 therapy is more costly, it yields additional QALYs, making it a cost-effective approach with an ICER of $44,578 per QALY. One-way sensitivity analysis showed that preconception GLP-1 RA therapy remained cost-effective at drug prices up to $6,058 annually. 

Conclusion:
This study demonstrates that one year of preconception GLP-1 RA therapy is a cost-effective strategy that improves perinatal outcomes in individuals with preexisting T2DM. These findings support the incorporation of GLP-1 RA therapy into pre-pregnancy diabetes management to reduce the risk of pregnancy-related complications in this high-risk population.