OBJECTIVES: Some of the nNIADs (sodium-glucose cotransporter-2 [SGLT2] inhibitors, glucagon-like peptide-1 [GLP1] receptor agonists) have cardio- and renalprotective effects, which led to a major change in diabetes treatment guidelines. The nNIADs have generally been found cost-effective (CE) compared to older pharmaceuticals, but which nNIAD is cost-effective is still unclear. Therefore, we aim to provide an overview of the cost-effectiveness analyses (CEA) of nNIADs using DAM to compare nNIADs for treatment of T2DM.

METHODS: A systematic literature search was performed from start 2018 to august 2021. PubMed, Embase and Econlit databases were used, and the following studies were included: CEAs using DAMs to compare the nNIAD classes and products.

RESULTS: The search yielded 34 eligible studies. GLP1 and SGLT2 products were main comparators (MC) in 20 and 12 studies, respectively, with two studies comparing several strategies with no MC. Eleven studies compared these two classes directly, out of which SGLT2 was CE in seven. The most frequently compared products, injectable or oral Semaglutide (n=14) and Empagliflozin (n=8), were CE when compared to products within their own classes. In the six studies with direct comparison between them, Semaglutide was CE in four. There was variation in model assumptions and content which was varied with MC class.

CONCLUSIONS: There is not enough evidence, and too much variation in studies, to conclude anything about CEness of the nNIADs. However, in the direct comparisons of the included studies, the SGLT2 class is more frequently CE or dominant compared to than GLP1. On product level, Semaglutide is more frequently CE. Variation in models make it difficult to draw conclusions in the field. We need a better practice for evaluating T2DM treatments with DAM, with an emphasis on central clinically relevant model assumptions, parameters, and comparators.