OBJECTIVES: In these cost-utility analyses CORE Diabetes Model and LEAD-1 and LEAD-6 trials data were used to compare liraglutide (a glucagon-like peptide-1 receptor agonist) to rosiglitazone, both in combination with glimepiride, and to exenatide, both with metformin and/or sulfonylurea. METHODS: The analyses were performed from the health care services payer’s perspective. In the base-case analysis a time horizon of 20 years has been chosen . The analysis compared patients treated with liraglutide 1.2 mg or rosiglitazone 4 mg (LEAD-1) or liraglutide 1.8 mg or exenatide 10 µg b.i.d. (LEAD-6). The analysis used health state utility values derived from literature. The cost of treatment and complications were based on officially published sources for medicines prices (www.mh.government.bg), for hospital charges (www.nhif.bg) and verified by expert opinion survey (1 BGN = 0.51 EUR). RESULTS: QALYs increased with liraglutide 1.2 mg by 0.252 (SD 0.129) years (LEAD-1). Total costs increased by BGN7,722 (€3,948) resulting in an incremental cost per QALY gained of BGN30,674 (€15,684). Based on LEAD-6 trial data liraglutide 1.8 mg resulted in increase of 0.151 (SD 0.124) QALYs. Total costs increased by BGN4,151 (€2,122) with incremental cost BGN27,404 (€14,012) per QALY. CONCLUSIONS: In Bulgarian health care system settings liraglutide added to standard treatment have been shown to be cost effective in comparison with rosiglitazone and exenatide for type 2 diabetes.