OBJECTIVES: To estimate cost-effectiveness of exenatide twice daily (BID) versus insulin glargine once daily (QD) as add-on therapy in Chinese type 2 diabetes patients not well controlled by oral anti-diabetic (OAD) agents. METHODS: The Cardiff model was populated with the data synthesized from three head-to-head randomized clinical trials up to 30 weeks in China comparing exenatide BID vs insulin glargine as add-on therapies to oral therapies in the Chinese population. The Cardiff model generated outputs including macrovascular and microvascular complications, diabetes-specific mortality, costs and quality-adjusted life years (QALYs). Cost and QALYs were estimated with time horizon of 40 years at a discount rate of 3% from the societal perspective RESULTS: Compared with insulin glargine plus OAD treatments, patients on exenatide BID plus OAD gained 1.88 QALYs, at an incremental cost saving of Chinese Renminbi (RMB) 114,593 (i.e., cost saving of RMB 61078/QALY). The cost-effectiveness results were robust to various sensitivity analyses including probabilistic sensitivity analysis. The variables with the most impact on incremental cost-effectiveness ratio included HbA1c level at baseline, health utilities decrement and BMI at baseline. CONCLUSIONS: Compared with Insulin glargine QD, exenatide BID as add-on therapy to OAD is a cost-effective treatment in the Chinese patients inadequately controlled by OAD treatments.