OBJECTIVES: People aged ≥65 years with T2DM contribute significantly to the increasing rate of health care utilization.  CANA, an agent that inhibits sodium glucose co-transporter 2 (SGLT2), and SAXA, a dipeptidyl peptidase-4 inhibitor, have provided meaningful HbA1c reductions when used as monotherapy and as add-on to other antihyperglycemic agents in older patients.  This analysis estimates the cost-effectiveness of CANA 100 or 300 mg versus SAXA 5 mg in patients with T2DM aged ≥65 years in the Canadian setting. METHODS: ECHO-T2DM was used to simulate outcomes associated with using CANA versus SAXA as an add-on therapy in patients with T2DM aged ≥65 years.  As head-to-head data were unavailable, an indirect comparison (IC) was performed using published data on SAXA 5 mg and results from a post hoc analysis of CANA data where possible (HbA1c and weight).  IC estimates were calculated for those inadequately controlled on a mix of different background therapies (lifestyle intervention alone or combination with metformin, metformin plus sulfonylurea, or metformin plus pioglitazone).  For other biomarkers (ie, cholesterol, systolic blood pressure) and adverse event rates, SAXA 5 mg values were assumed to be equal to those of placebo in the post hoc analysis.  The post hoc dataset was also the source of the background patient characteristics.  Costs and benefits were discounted at 5% and assessed from the Canadian perspective.  Sensitivity analyses were performed. RESULTS: Both CANA 100 and 300 mg were dominant compared to SAXA 5 mg (lower net cost and greater quality-adjusted life-years [QALYs]).  CANA 100 and 300 mg reduced costs (–$375 and –$771, respectively) and improved QALYs (0.033 and 0.057, respectively) over 40 years.  Sensitivity analyses support these findings. CONCLUSIONS: These results suggest that using CANA in older individuals is cost-effective versus SAXA in Canada.