OBJECTIVES To evaluate the cost-effectiveness of canagliflozin, an active inhibitor of sodium glucose co-transporter – 2 (SGLT2), in triple therapy of diabetes as add-on to metformin and sulfonylurea compared to NPH insulin in combination with oral antidiabetics. Canagliflozin in clinical trial results showed effective glucose reduction, along with other benefits in diabetes treatment including weight loss and SBP reduction. Cost effectiveness analyses were conducted in the Polish setting from a public perspective in accordance with guidelines of Polish HTA Agency (PolAHTA). METHODS The IMS CORE Diabetes Model was used to evaluate the cost-effectiveness of canagliflozin in triple therapy versus NPH insulin using Polish-specific data, where available. Clinical data were derived from mixed treatment comparison analysis of published studies, as there is no head to head trial comparing canagliflozin with NPH insulin. Direct costs were reported in Polish zloty and an annual discount rate of 5% and 3.5% were applied on costs and effects respectively. RESULTS In a triple therapy as add-on to metformin and sulfonylurea canagliflozin is a cost- effective treatment option in comparison with NPH insulin with ICERs of 4 477 z³ and 69 081 z³  for canagliflozin 100 mg and 300 mg respectively. Associated QALY gains were 0,084 and 0,106. Both results are below defined in Polish reimbursement act cost-effectiveness threshold. CONCLUSIONS These results suggest that adding Canagliflozin to dual therapy versus insulin intensification in patients inadequately controlled with MET+ SU would be a more efficient use of healthcare resources in the Polish setting.