OBJECTIVES

: To estimate cost-effectiveness of dapagliflozin a SGLT2 inhibitor, therapeutic class which has been recommended by the American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE), as the first-election add-on oral therapy to metformin in patients with type 2 diabetes who do not achieve adequate glycemic control in comparison with currently used oral antidiabetics in the public health system in Mexico.

METHODS

: A cost-effectiveness analysis was conducted considering the use of dapagliflozin in comparison to three different dipeptidyl-peptidase-4 inhibitors (DPP4i), as add-on alternatives to metformin in type 2 diabetes (T2D) adult patients with inadequate glycemic control with metformin monotherapy. Basal clinical characteristics were obtained from Health and Nutrition National Survey; efficacy measured as decrease of HbA1c for every comparator were obtained through a systematic literature review. Input data was analyzed with a transitional model considering UKPDS risk equations to estimate complications associated to inadequate glycemic control and mortality; adverse events were also included. Effectiveness was measured as life years gained. An institutional perspective was considered, pattern of use of resources and direct costs were obtained from public health institutions in Mexico, time horizon of 10 years and a discount rate of 5% was used. Results were presented as cost per LYG and dominance. Sensitivity analyses were performed to assess robustness of results. Costs are expressed in 2017 USD.

RESULTS

: Dapagliflozin+metformin resulted in a lower cost per LYG when compared to DPP4i+metformin (dapagliflozin+metformin: $1,796.82/LYG; vildagliptin+metformin: $1,851.86/LYG; linagliptin+metformin: $1,853.08; sitagliptin+metformin: $1,857.43) and demonstrated an incremental efficacy of 0.102 LYG. Dapagliflozin+metformin resulted in the dominant alternative in comparison to DPP4i+metformin. Sensitivity analysis showed consistency with base case.

CONCLUSIONS

: Using dapagliflozin, a SGLT2 inhibitor as recommended by AACE/ACE, before DPP4i as add-on therapy to metformin, results in clinical and economic benefits to T2D patients and public health system in Mexico.