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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
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Risk stratification using coronary artery calcium and potential benefit of semaglutide therapy: A cost-effectiveness

Sai Rahul Ponnana1, Tong Zhang1, Santosh Kumar Sirasapalli1

  • 1Case School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

Diabetes, Obesity & Metabolism
|February 2, 2026
PubMed

Insights

Coronary artery calcium (CAC) scoring helps predict major adverse cardiovascular events (MACE) risk. This study found semaglutide therapy is more cost-effective for individuals with higher CAC scores, suggesting CAC can guide treatment decisions.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacoeconomics
  • Obesity Management

Background:

  • Coronary artery calcium (CAC) scoring effectively stratifies risk for major adverse cardiovascular events (MACE).
  • Semaglutide is a highly effective anti-obesity medication, but its high cost limits accessibility.
  • Cost-effectiveness of semaglutide therapy in relation to CAC scores requires investigation.

Purpose of the Study:

  • To evaluate the cost-effectiveness of semaglutide treatment across different coronary artery calcium (CAC) scoring groups.
  • To determine the clinical benefit and economic value of semaglutide based on CAC-defined cardiovascular risk.

Main Methods:

  • Utilized data from 38,058 CLARIFY registry participants meeting SELECT criteria, stratified by CAC score (0, 1-99, 100-399, ≥400).
  • Estimated MACE risk using multivariable-adjusted Cox proportional hazard models.
  • Developed lifetime-horizon Markov models to simulate semaglutide therapy, calculating number needed to treat (NNT) and incremental cost-effectiveness ratios (ICER).

Main Results:

  • Higher CAC scores correlated with increased MACE risk, including myocardial infarction, heart failure, stroke, and all-cause mortality.
  • Semaglutide therapy showed potential MACE NNT values of 151 for CAC=0 and 34 for CAC≥400 over 3.3 years.
  • The incremental cost-effectiveness ratio (ICER) for semaglutide decreased significantly with higher CAC scores, from $625,863/QALY for CAC=0 to $168,666/QALY for CAC≥400.

Conclusions:

  • Coronary artery calcium (CAC) scoring can serve as a valuable tool for assessing the potential clinical benefits and cost-effectiveness of lifelong semaglutide therapy in obese individuals.
  • CAC scoring may aid in personalizing treatment strategies for semaglutide to optimize outcomes and resource allocation.
Abstract

Keywords:
antiobesity drugcohort studydatabase researchrisk predictionsemaglutide

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