The cardiovascular result is the strongest thing anyone can say about this drug class, and it is the claim most likely to be repeated to you with a price attached. It is worth knowing what the trial found, what size the effect was, and what the thing being sold has in common with the thing tested — which is less than the sentence usually implies. It is the same question, asked of a harder endpoint, as is a GLP-1 worth what it costs.
What the trial found
SELECT enrolled 17,604 patients aged 45 or over with pre-existing cardiovascular disease and a BMI of 27 or greater, but no history of diabetes, and randomized them 1:1 to weekly semaglutide at 2.4 mg or placebo [1]. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke.
Over a mean follow-up of 39.8 months, that endpoint occurred in 569 of 8,803 patients on semaglutide (6.5%) and 701 of 8,801 on placebo (8.0%) — a hazard ratio of 0.80 (95% CI 0.72 to 0.90, p<0.001). The mean duration of exposure to the drug was 34.2 months.
What it cost the people in it
Adverse events leading to permanent discontinuation happened to 1,461 patients on semaglutide (16.6%) and 718 on placebo (8.2%). One in six people randomized to the drug stopped taking it because of how it made them feel — in a trial, with study staff, at no cost to the participant. That figure belongs beside any discussion of a three-year course, and it is the same pattern we count in who is still taking it after a year.
What three years would cost here
The trial dosed for a mean of 34.2 months. Across the 432 injected semaglutide figures on this roster, the median billed rate is $179 a month, running from $69 to $449 — a spread of 6.5×. At the median, 34 months comes to $6,086. At the cheapest published figure it is $2,346; at the dearest, $15,266. Roster read September 2026.
Those are the numbers, and here is the caveat that matters more than any of them: none of these sellers is selling the drug the trial used. SELECT ran on brand semaglutide at a fixed 2.4 mg. Most of this roster sells a compounded preparation, at a milligram that is usually not published — a silence we count in what happens at a higher dose. A cardiovascular outcome measured on one product is not a property of every product containing the same molecule name.
How to read a claim built on this trial
If a seller’s page tells you this drug reduces cardiovascular risk, the honest version of that sentence has four conditions attached: brand semaglutide, 2.4 mg weekly, about three years, in people who already had cardiovascular disease. Strip any one of those and the result does not transfer — and the price you are being shown almost certainly assumes you will strip at least two.
The practical question is therefore not whether the trial is good. It is. The question is what you are actually buying and for how long, which is the arithmetic in what a GLP-1 actually costs, and whether the figure you started from survives the second month — covered in the headline is not the bill.