OBJECTIVES: Type 2 diabetes mellitus (T2DM) treatment guidelines recommend therapy intensification with a second oral agent if glycated hemoglobin (HbA1c) target is not achieved over three to six months. However, in clinical practice, therapy intensification occurs as soon as one month.

The objective of this study was to compare the cost-effectiveness of treatment intensification with metformin/ DPP4i inhibitor fixed-dose combination in uncontrolled patients (HbA1c > 7.5%) at three versus one month(s) after metformin XR monotherapy initiation.

METHODS: A discrete event simulation model was created based on UKPDS and a comprehensive literature review was performed in order to model lifetime therapeutic sequence in T2DM. This model was adapted to include a monthly HbA1c profile progression, an adherence impact on effectiveness and to consider Saudi Arabian specific data. This model allowed the lifetime assessment of quality adjusted life years (QALY), persistence in metformin, time to insulin therapy, percentage of patients with diabetes complications and costs.

RESULTS: Postponing therapy intensification will lead to more patients achieving HbA1c target, augmenting metformin monotherapy (3 months group: 3.58 years vs