OBJECTIVES: Our aim was to assess cost-utility ratios of liraglutide, a GLP-1 receptor agonist, in comparison with rosiglitazone, glimepiride and exenatide for type 2 diabetes in Romanian health care system settings. METHODS: The CORE Diabetes Model and clinical data from LEAD-1 (liraglutide vs rosiglitazone, both with glimepiride, 1st case), LEAD-2 (liraglutide vs glimepiride, both with metformin, 2nd case) and LEAD-6 trial (liraglutide vs exenatide, both with metformin and/or sulfonylurea, 3rd case) trials were used. The health care services payer’s perspective and 20-year time horizon have been chosen. Health state utility values and cost date were based DRG Data from “Center for Research and Evaluation of Healthcare Services”, Romania, CaNaMed National Catalog of Medicines Prices (official tariff lists) and expert opinion. RESULTS: In the 1st case QALYs increased by 0.201 (SD 0.105) years with liraglutide 1.2 mg and by 0.231 (SD 0.107) years with liraglutide 1.8 mg. Total costs increased by €3,266 and €5,378 resulting in an incremental cost per QALY gained of €16,209 and €23,282, respectively. In the 2nd case, liraglutide 1.2 mg resulted in increase of 0.155 (SD 0.099) QALYs and liraglutide 1.8 mg 0.170 (SD 0.146) QALYs with incremental cost per QALY gained of EUR 29,909 and EUR 38,830, respectively. In the 3rd case QALYs increased by 0.125 (SD 0.102) years with liraglutide 1.8 mg, total costs increased by €1898, an incremental cost was €15,123 per QALY. CONCLUSIONS: Based on efficacy data from clinical trials and validated model liraglutide has been shown to be cost effective when compared with rosiglitazone, glimepiride and exenatide for the treatment of type 2 diabetes.