OBJECTIVES: This study aimed to review the long-term cost-effectiveness of glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of type 2 diabetes (T2D).

METHODS: The PRISMA guideline was used in the partial update of a systematic review by Hong, et al. from 2019 assessing the cost-effectiveness of T2D drugs focused on GLP-1 receptor agonists. The search strategy included the Medical Subject Heading (MeSH) term ‘economics,’ ‘cost,’ ‘cost-effectiveness,’ ‘value,’ and ‘cost-utility,’ as well as all names for GLP-1s. The search strategy was used in the PubMed/MEDLINE, EMBASE, and CINAHL Plus databases (from 2 June 2018 to 7 December 2021). Studies assessing GLP-1 drugs from the initial review were included.

RESULTS: In total, 80 articles were found that used a validated diabetes model to determine if short-term treatment effects from clinical trials such as HbA1c reduction led to the long-term cost-effectiveness of GLP-1s versus other T2D drugs. Of the 80 articles, 51 were from the initial review and 29 were from the updated search. Comparative drugs included other GLP-1s (n=30), insulin (n=31), sodium-glucose transport protein 2 inhibitors (SGLT2) (n=14), dipeptidyl-peptidase 4 (DPP4) (n=13), sulfonylureas (n=5), and thiazolidinediones (TZD) (n=3). Newer GLP-1s were considered cost-effective compared to existing GLP-1s. GLP-1 was considered cost-effective, and dominant compared to TZDs and sulfonylureas. In studies comparing GLP-1s to SGLT2s, GLP-1s were cost-effective. However, 5 studies found it non-dominant to SGLT2s. Although GLP-1s were cost-effective compared to DPP4s, 2 studies found that DPP4s were more cost-effective than GLP-1s. 30 of the 31 studies comparing GLP-1s to insulin found GLP-1s to be a cost-effective treatment; 1 article found GLP-1s not to be cost-effective.

CONCLUSION: The review shows strong and consistent evidence that long term, GLP-1s are cost-effective for patients with uncontrolled T2D. A more complete update of the review should focus on the cost-effectiveness of other T2D drugs.