OBJECTIVES: Linagliptin is a new oral hypoglycaemiant agent (OHA) from the class of dipeptidyl peptidase 4 (DPP-4) inhibitors, mostly excreted by biliary pathway, that has no contra-indication in renal impaired patients. Linagliptin in indicated for dual therapy (add on to metformin) and for triple therapy (add on to metformin and Sulfamides).”. The aim of this study is to estimate the potential budget impact of linagliptin (either as mono substance or in combination with metformin) from most current DPP-4 inhibitor prescribing patterns. METHODS: A budget impact model was developed from a French payer perspective. The model focused on drugs and insulin administration costs. Three prescription patterns were considered for linagliptin treatment initiation: substitution without treatment intensification, substitution with treatment intensification and initiation in naïve patients. Treatment initiation data were obtained via retrospective analysis of 2011 prescribing data from the Thales database. DPP-4 inhibitors latest entrants (saxagliptin/vildagliptin-metformin combinations) were used as benchmark for linagliptin. For analysis purpose, the daily cost of linagliptin was assumed at market average (1.19€/day exfactory). RESULTS: Considering a virtual cohort of 10,000 patients treated with linagliptin (mono or combination with metformin), the whole treatment cost over 5 years would be 21,717 k€ compared with 18,996 k€ for a cohort of the same size treated with current alternatives. Benefits were observed among patients receiving triple therapy mainly because of competition with substitution of more expensive drugs such as GLP1 analogues and insulins. Sensitivity analysis showed that deploying the “add on to insulin indication” could reduce the budget impact up to 8 %.  CONCLUSIONS: The estimated budget impact of linagliptin will be close to neutrality, as around 87.5 % of linagliptin costs are already offset by substitutions, based on conservative assumptions.