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Cost per QALY: the price is the assumption that decides the answer

A model put semaglutide at $19,911 per quality-adjusted life year — a very good number. Two of its three authors work for the company that sets the price it used.

Carla Medina6 min read
Modeled cost per QALY gained$150k thresholdsemaglutide 2.4 mgresmetirom 100 mgresmetirom 80 mg

Cost-effectiveness analysis is how health systems decide what to pay for, and its output is a single number: the cost of buying one extra year of life in good health. A recent model produced an unusually favorable one for semaglutide, and the interesting part is not the number. It is which assumption the number rests on.

What the model did

The analysis took a US third-party payer perspective and simulated a lifetime horizon for patients with non-cirrhotic metabolic dysfunction-associated steatohepatitis and moderate to advanced fibrosis — a liver condition, not weight loss. [1] It compared semaglutide 2.4 mg and two doses of resmetirom against standard of care, drawing transition probabilities from published trials, costing everything in 2025 dollars and discounting costs and outcomes at 3% a year. That is a conventional and competently specified design, quite unlike the arithmetic a buyer does at a checkout, which has no horizon at all.

In the base case, semaglutide produced 1.66 additional quality-adjusted life years at an incremental cost of $33,031, giving an incremental cost-effectiveness ratio of $19,911 per QALY gained. Resmetirom 80 mg produced 1.20 additional QALYs at an incremental cost of $415,110, and resmetirom 100 mg 1.24 QALYs at $245,991 — ratios of $346,810 and $198,607 per QALY. At a willingness-to-pay threshold of $150,000, semaglutide was cost effective in 99.5% of simulations.

Who built it

Two of the three authors are employees and shareholders of Novo Nordisk, which makes semaglutide. The third is employed by a research firm that Novo Nordisk contracted to develop the model and write the manuscript. The comparator drug, resmetirom, is made by somebody else.

The input that decides everything

An ICER is a fraction. The numerator is the incremental cost of the drug and the denominator is the health it buys. The denominator comes from trials. The numerator comes, largely, from a price — and a price is the input a manufacturer knows best and controls outright. On this roster the same input moves constantly, which is why a twelve-month plan is priced against a moving figure.

The authors evidently understood that, because they ran a scenario analysis using the direct-to-consumer cash price of $499 a month rather than a payer-negotiated cost. That scenario is named in the published abstract; its result is cut off before the figure, so this page does not report one. What the scenario establishes is that the choice of price was known to matter enough to test.

That $499 figure is worth holding next to this roster. Sellers here publish a median of $179 a month for semaglutide by injection, read September 2026$320 below the direct-to-consumer price the model used as its consumer-facing scenario. These are not the same product in a regulatory sense, and most of the roster is compounded rather than branded, which is a real difference and not a discount. But it does mean the cheapest input anybody could plug into that model is not the one in it. You can see the spread in the price check.

What a QALY figure is worth to you

Almost nothing directly, and it is worth being clear about why. A QALY threshold is a system-level judgment about what a population should collectively fund. It is not a statement that a given purchase is a good deal for a given person, and a buyer paying cash has no threshold, no lifetime horizon and no discount rate.

What it is good for is calibration. A drug at $19,911 per QALY and a drug at $346,810 per QALY are not close, and that ordering is unlikely to flip on a price assumption alone. Directional conclusions from a model survive better than exact ones — the same rule that applies to weighing the money against the outcome at the individual level. Treat the ranking as informative and the decimal places as somebody’s assumption.

Frequently asked

What is a QALY?
A quality-adjusted life year — one year of life in full health. Health systems use cost per QALY to compare treatments that do entirely different things, and commonly treat $50,000 to $150,000 per QALY as the affordable range.
Does $19,911 per QALY mean the drug is cheap?
It means a model said the health it buys is good value at the price that model assumed, for a liver condition rather than for weight loss. A cash buyer has no threshold and no lifetime horizon, so the figure does not transfer to a personal purchase.
Should the authors' employer change how I read it?
It should change how much weight you give the exact figure, not whether you believe the ranking. Manufacturer-sponsored models are standard and fully disclosed here; the inputs are still chosen by a party with an interest in the output.
What did the $499 scenario find?
This desk cannot say. The published abstract names the direct-to-consumer price scenario and is cut off before reporting its result, so no figure for it appears on this page.

Sources

  1. [1] McGovern AJ, et al. (2026). 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 PharmacoEconomics. PMID 42503575

Where to get it

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Every seller that publishes a price, ordered lowest first on the standing month-to-month rate, plus the question to ask before you pay any of them.

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