OBJECTIVES: Type-2 diabetes mellitus (T2DM) is a progressive chronic disease placing a huge clinical and financial burden on healthcare services.  A recent randomized open-label clinical trial (NCT00082381) comparing exenatide with insulin glargine provided evidence of the short-term clinical profile of exenatide.  The objective of this cost-effectiveness analysis was to use these results as the basis for long-term projections to estimate the clinical and cost outcomes associated with exenatide treatment versus insulin glargine over a 15-year time horizon in a Turkish setting. METHODS: The analysis used the previously published and validated IMS Core Diabetes Model, comprised of a series of Markov-based submodels simulating the major complications of diabetes (cardiovascular, renal, eye and neurological disease).  Using baseline characteristics (mean age 58.9 years; 55.7% male; mean HbA1c 8.21%; mean duration of diabetes 9.56 years), complications and concomitant medications from study NCT00082381, analysis was performed using a non-parametric bootstrapping approach where disease progression was simulated to estimate costs, life expectancy and quality-adjusted life expectancy (QALE). RESULTS: Exenatide treatment was projected to improve life expectancy (mean[SD] years: 8.41[0.09]) and QALE (mean[SD] quality-adjusted life years [QALY]: 6.00[0.07]) compared with insulin glargine (mean[SD] years: 8.38[0.08]; mean[SD] QALY: 5.62[0.06]), while also delaying the onset of diabetes-related complications (years to onset: exenatide: 4.04; insulin glargine: 4.00).  Lifetime direct medical costs were higher for exenatide with a mean(SD) of 53,573(819) New Turkish Lira (YTL) compared with insulin glargine YTL 42,361(770). The incremental cost-effectiveness ratio (ICER) based on QALE for exenatide was YTL 30,018 per QALY gained versus insulin glargine. CONCLUSIONS: The outcome of this analysis was that exenatide treatment was projected to improve life expectancy and QALE and reduce cumulative incidence of most diabetes-related complications including cardiovascular disease, compared with insulin glargine. By current Turkish standards, the ICER for exenatide would be considered to represent good value for money.