OBJECTIVES: Sulphonylureas available in Malaysia include glibenclamide, gliclazide, glimepiride and glipizide providing varying degree of benefits and risks. In this study we review and compare overall utility values of sulphonylureas using medicines scoring system (MedSS). METHODS: MedSS, a previously developed scoring framework based on multicriteria decision analysis (MCDA) that systematizes evaluation of drug attributes was used. An expert panel of 3 endocrinologists, 1 family physician and 5 pharmacists were formed. A group of medicine reviewers assisted in evidences search and reviews. Through expert panel discussions, drug attributes were identified and weighted. Based on evidences, attribute scores were allocated and added up to provide total utility score (TUS). Cost savings was calculated based on 25% reduction in utilization of drug with the lowest TUS. RESULTS: Attributes identified and selected for analysis were efficacy (clinical efficacy, clinical endpoints), safety (interactions, side-effects, hypoglycaemia, documentation, cardiovascular effects, combination with insulin and use in special population), patients’ acceptability (formulation, dose frequency, weight change) and cost. The average weights assigned by panel members for efficacy, safety, patients acceptability and cost were 23.89%, 43.89%, 20.33%, and 11.89%, respectively. Gliclazide scored consistently high for both efficacy and safety attributes resulting in TUS of 68.5 and 67.4 for gliclazide modified release and gliclazide respectively. Safety concerns lowered the TUS for glibenclamide to 56.8. Potential direct savings on drug costs was estimated to be over RM3 million per year resulting from reduction in glibenclamide utilization from 30% to 5%. CONCLUSIONS: MedSS successfully organized the attributes and utilities of the drugs compared, distinguishing gliclazide as the superior alternative. Providing patients with access to drugs of higher TUS could additionally results in indirect savings beyond drug costs. Moreover, benefits of clinicians’ involvement are twofold: better acceptance of any changes to the formulary list leads to improved prescribing pattern that could also positively impact drug expenditures.