SELECT cost-effectiveness — looking for input

quinn_sf said:

Positive "side effect" of cardiovascular risk: my blood pressure dropped so much that I'm now off lisinopril entirely!

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk. In 3,297 T2DM patients with high CV risk: MACE HR 0.74 (95% CI 0.58-0.95, p=0.02)[1].

Notable: the retinopathy signal in SUSTAIN-6 (HR 1.76) was subsequently attributed to rapid A1C reduction in patients with pre-existing retinopathy — not a direct drug effect. This has been confirmed in longer-term follow-up studies.

quinn_sf said:

Positive "side effect" of cardiovascular risk: my blood pressure dropped so much that I'm now off lisinopril entirely!

Saving this. It is the first explanation that did not require me to already understand it. Printing the relevant bit and taking it with me.

From the other side of the consultation, briefly.

NNT calculation for cardiovascular risk clinical endpoints: NNT = 1/ARR (absolute risk reduction).

From SELECT trial: MACE at 39 months — 6.5% semaglutide vs 8.0% placebo. ARR = 1.5%. NNT = 67 over 3.3 years.

Compare to established therapies:

These NNTs are clinically meaningful and comparable to accepted cardiovascular interventions.

Dr.PulmRoch said:

NNT calculation for cardiovascular risk clinical endpoints: NNT = 1/ARR (absolute risk reduction).

Adding a me-too, because a thread of one person's experience is not much use. I had assumed I was the exception until I read this.

Closing the loop on my own question.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.