OBJECTIVES: to assess the cost effectiveness of saxagliptin (SAXA) vs sitagliptin (SITA) or vildagliptin (VILDA) as add-on therapy to metformin (MET) in patients with type 2 diabetes mellitus (T2DM) and inadequate glycaemic control on metformin alone. METHODS: the Cardiff Diabetes Model was adapted to the Russian healthcare setting. We modeling events, efficacy, total costs for managing patients with T2DM: 1-st line – monotherapy metformin alone, 2-nd line (target groups) – SAXA or SITA or VILDA plus metformin, 3-nd line – insulin rescue therapy. The model simulated the disease progression and treatment effects for 40 years (8-26-6 years for 1-2-3 lines respectively). The effectiveness measure was quality-adjusted life years (QALYs) gained per patient. RESULTS: in case short-time efficacy (decrease HBA1c -1%) cost-effectiveness ratio (CER) for SAXA+MET was the lowest: $835 per QALY. When compared with SITA+MET for the long-term efficacy (40 years), SAXA+MET was the dominant strategy, i.e. less costly (-$505) and more effective (+0.16 QALY). When compared to VILDA+MET, SAXA+MET was more costly (+$364), but more effective (+0.14 QALY). The incremental cost-effectiveness ratio (ICER) per responder for SAXA+MET vs VILDA+MET was estimated at $2,566 per QALY gained and would be cost effective at the willingness-to-pay (WTP) threshold $36,373/QALY for Russia in 2014. If we used combined medicines: Kombiglyce (SAXA+MET), Janumet (SITA+MET) and Galvus Met (VILDA+MET), then Kombiglyce interventions were also more efficacious than Janumet and Galvus Met, but were associated with increased total costs. The ICERs per responder for Kombiglyce were estimated at $3,216/QALY (vs Janumet), $3,269/QALY (vs Galvus Met) and would be cost effective at the WTP threshold $36,373/QALY for Russia in 2014. CONCLUSIONS: at a willingness-to-pay threshold of $36,373/QALY SAXA+MET and Kombiglyce is likely to be a cost-effective option for the treatment of T2DM in adult patients in Russia.