OBJECTIVES: Proper glycemic control reduces the frequency of microvascular and macrovascular complications in type 2 diabetes.  Many patients require more than one medication to reach goal glycated hemoglobin (A1c) levels.  The objective of this study was to assess the cost-effectiveness of dapagliflozin versus the  dipeptidyl pepdtidase 4-inhibitors in regards to cost per unit of A1c lowered.   METHODS: Data for clinical outcomes were abstracted from a meta-analysis comparing the effectiveness  of oral diabetes medications added to metformin for type 2 diabetic patients failing to achieve goal Alc levels with metformin alone.  All comparisons in the meta-analysis were for a 52 week period.  A random effects regression model was utilized to compare dapagliflozin to dipeptidyl peptidase 4-inhibitors in their ability to lower glycemic levels after adjusting for baseline Alc and additional covariates.  The costs for the antidiabetic agents were based on published wholesale acquisition costs data for 2014.  An incremental cost effectiveness ratio (ICER) was calculated to determine cost per additional percentage point for lowering the A1c from the health payer perspective. RESULTS: Dapagliflozin was more effective than dipeptidyl pepdtidase 4-inhibitors in lowering A1c levels and was associated and additional 0.07% lowering of the A1c level after adjusting for covariates.  Dapagliflozin was more expensive at an annual cost of $3,470.40 while dipeptidyl pepdtidase 4-inhibitors had an annual costs of $3,405.60.  The resulting ICER indicated that there was a cost $926 for each additional percentage point that the Alc was lowered by using dapagliflozin.   CONCLUSIONS:  Dapagliflozin was more effective than dipeptidyl pepdtidase 4-inhibitors in lowering A1c levels, yet it was also more expensive.  Decision makers trying to decide whether or not to use these medications must be prepared to decide if the additional benefit is worth the cost.