OBJECTIVES : This study aimed to systematically review cost-effectiveness studies of newer antidiabetic medications.

METHODS : PubMed/MEDLINE, EMBASE, CINAHL Plus, Cochrane Library-NHS Economic Evaluation Database (Wiley), Cochrane Library-Health Technology Assessment Database (Wiley), Cochrane Library-Database of Abstracts of Reviews of Effects (Wiley), and Cost-Effectiveness Analysis Registry (01/01/2000-06/01/2018) were searched. Inclusion criteria included (1) cost-effectiveness studies of the newer antidiabetic medications including sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors, and (2) full-text publication in English. Two reviewers independently screened the titles, abstracts, and full-text articles to select studies for data extraction. Discrepancies were resolved by discussions and consensus. Quality of reporting cost-effectiveness analysis was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guideline.

RESULTS : Among 86 studies selected, 83 studies clearly stated the types of diabetes model used (e.g., CORE model), and 71 studied used validated diabetes models. 75 (87%) studies were funded by pharmaceutical companies, and 73 (85%) studies were conducted from payer’s perspective. 77 (89%) studies presented good quality (20-24 CHEERS items), nine were of moderate quality (14-19 items), and one had low quality (less than 14 items). 30 studies compared newer antidiabetic medications with insulin, three studies compared newer antidiabetic medications with thiazolidinediones (TZDs), 15 studies compared newer antidiabetic medications with sulfonylureas, 41 studies compared new antidiabetic medications with alternative newer antidiabetic medication, and nine studies compared with other antidiabetic agents that were not included above. Newer antidiabetic medications were reported to be cost-effective in 26 out of 30 (87%) studies comparing with insulin, and 13 out of 15 (87%) studies comparing with sulfonylureas.

CONCLUSIONS : Most economic evaluations of antidiabetic medications have good reporting quality and use validated diabetes models. The newer antidiabetic medications in most of reviewed studies were found to be cost-effective, compared to insulin, TZDs, and sulfonylureas.