Limwongse S, Chatpattanasiri P, Phuphuang P, Tungthaweethong K, Sutheerayongprasert K, Aunprom-Me W, Kositamongkol C, Phisalprapa P. Cost-utility analysis of glucagon-like peptide-1 receptor agonists for type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease in Thailand. World J Hepatol 2026; 18(10): 123353 [DOI: 10.4254/wjh.123353]
Corresponding Author of This Article
Pochamana Phisalprapa, MD, PhD, Associate Professor, Lecturer, Senior Researcher, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, No. 2 Wanglang Road, Siriraj, Bangkok Noi, Bangkok 10700, Thailand. pochamana.phi@mahidol.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2026; 18(10): 123353 Published online Oct 27, 2026. doi: 10.4254/wjh.123353
Cost-utility analysis of glucagon-like peptide-1 receptor agonists for type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease in Thailand
Sirada Limwongse, Paninnuch Chatpattanasiri, Phonnaphat Phuphuang, Krisada Tungthaweethong, Keerati Sutheerayongprasert, Watkornphat Aunprom-Me, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Chayanis Kositamongkol, Pochamana Phisalprapa, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Co-first authors: Sirada Limwongse and Paninnuch Chatpattanasiri.
Author contributions: Kositamongkol C and Phisalprapa P designed the study; Limwongse S, Chatpattanasiri P, Phuphuang P, Tungthaweethong K, Sutheerayongprasert K, Aunprom-Me W and Kositamongkol C collected and analyzed the data; Limwongse S, Chatpattanasiri P, Phuphuang P, Tungthaweethong K, Sutheerayongprasert K, Aunprom-Me W and Kositamongkol C performed the manuscript preparation; Kositamongkol C and Phisalprapa P participated in the review and editing; all authors have read and approved the final manuscript. Limwongse S and Chatpattanasiri P contributed equally to this work as co-first authors.
AI contribution statement: Portions of this manuscript were edited using AI tools (Perplexity) solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional animal care and use committee statement: Not applicable, as this study did not involve animal subjects.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at the Faculty of Medicine Siriraj Hospital, Mahidol University, No. Si-568/2024.
Informed consent statement: The informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Pochamana Phisalprapa, MD, PhD, Associate Professor, Lecturer, Senior Researcher, Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, No. 2 Wanglang Road, Siriraj, Bangkok Noi, Bangkok 10700, Thailand. pochamana.phi@mahidol.ac.th
Received: May 18, 2026 Revised: July 17, 2026 Accepted: September 15, 2026 Published online: October 27, 2026 Processing time: 158 Days and 22.4 Hours
Abstract
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD), a common chronic liver disease, is strongly associated with type 2 diabetes mellitus (T2DM). When accompanied by liver fibrosis, MASLD increases morbidity and mortality through metabolic risk and potential progression to cirrhosis and hepatocellular carcinoma. Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated efficacy in reducing fibrosis severity in MASLD. However, their substantial cost limits widespread use in resource-limited settings.
AIM
To evaluate the cost-effectiveness of GLP-1 receptor agonists compared with usual care in Thai adults with T2DM and MASLD.
METHODS
A Markov model was used to estimate the lifetime health benefits and costs of GLP-1 receptor agonists in adults with T2DM and MASLD from a societal perspective. The model compared 3 treatment alternatives: Semaglutide, Liraglutide, and Usual care. Input parameters were derived from systematic reviews and local databases. The results were reported as incremental cost-effectiveness ratios (ICERs) in Thai baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity and threshold analyses were performed.
RESULTS
The ICERs, compared with usual care, were 4580634 THB/QALY gained for semaglutide and 1709766 THB/QALY gained for liraglutide. At the willingness-to-pay threshold of 160000 THB/QALY gained, neither drug was cost-effective in Thailand. Price reductions of 96.51% for semaglutide and 90.64% for liraglutide would be required to achieve cost-effectiveness. One-way sensitivity analysis identified treatment efficacy, utility in MASLD stage F3, and the discount rate as the most influential parameters. Probabilistic sensitivity analysis confirmed these findings, with both treatments unlikely to be cost-effective relative to usual care.
CONCLUSION
Semaglutide and liraglutide are not cost-effective. Further clinical research and drug price negotiation are needed to make these treatments cost-effective and feasible in the Thai healthcare context.
Core Tip: This cost-utility analysis evaluated semaglutide and liraglutide for adults with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease in Thailand. Using a lifetime Markov model, we found that the incremental cost-effectiveness ratios of both drugs, relative to usual care, exceeded the national willingness-to-pay threshold. Neither drug was therefore cost-effective. Achieving cost-effectiveness would require price reductions exceeding 90%. These findings underscore the urgent need for drug price negotiations to improve treatment access within Thailand’s healthcare system.
