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Two trials in the PIONEER programme have assessed oral semaglutide in populations with inadequate glycaemic control on metformin with or without an SGLT-2 inhibitor: PIONEER 4 and PIONEER 7.27 28 A substantially greater number of patients were receiving metformin plus an SGLT-2 inhibitor at baseline in PIONEER 4, which compared oral semaglutide 14 mg with liraglutide 1.8 mg and placebo, with oral semaglutide associated with significantly improved HbA1c and BMI versus placebo, factors that could influence the incidence of long-term diabetes-related complications.38 10 29 Therefore, the present study aimed to evaluate the long-term cost-effectiveness of early use of oral semaglutide in people with type 2 diabetes with inadequate glycaemic control on metformin plus an SGLT-2 inhibitor in the UK, compared with remaining on their current therapies and delaying oral semaglutide initiation for a further 2 years, based on subgroup data from PIONEER 4

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