Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT-2i) are both indicated for the treatment of Type 2 diabetes mellitus (T2DM). Liraglutide and dapagliflozin are the most commonly prescribed GLP-1RA and SGLT-2i treatments in Spain, respectively. This study investigated the cost-effectiveness of liraglutide versus dapagliflozin for the treatment of T2DM in Spain.

METHODS:

The IMS CORE Diabetes Model (CDM), a validated simulation model, was used to estimate expected costs and outcomes. Patients with T2DM who had failed prior therapy with metformin received liraglutide 1.2mg or 1.8mg as interventions versus dapagliflozin 10mg as comparator, in addition to continuing metformin (dual therapy). Comparative efficacy was extracted from a network meta-analysis. Utility inputs came from a systematic literature review. A Spanish national payer perspective was assumed and analysis run over a lifetime time horizon. Sensitivity analysis considered a cohort receiving liraglutide or dapagliflozin in combination with two other anti-diabetic drugs (triple therapy).

RESULTS:

In dual therapy, liraglutide 1.2mg resulted in a QALY gain of 0.07 vs dapagliflozin 10mg at an additional cost of €421 (ICER: €6,486 per QALY gained), whereas results for liraglutide 1.8mg found a QALY gain of 0.08 at an additional cost of €1,480 (ICER: €17,966 per QALY gained). In triple therapy, QALY gain with liraglutide 1.2mg vs dapagliflozin 10mg was similar (0.07) and incremental cost was €578 (ICER: €8,932 per QALY gained), while increases in efficacy and costs were observed for liraglutide 1.8mg (ICER: €17,703 per QALY gained).

CONCLUSIONS: When administered as dual combination therapy with metformin, liraglutide 1.2mg and 1.8mg compared to dapagliflozin 10mg resulted in a small improvement in health gain, modest incremental cost and acceptable cost-effectiveness. These results are broadly consistent with findings in triple therapy. Both doses of liraglutide, 1.2mg and 1.8mg, may present cost-effective treatment alternatives to dapagliflozin in dual and triple combination therapy in Spain.