OBJECTIVES

: The approval of new non-insulin treatments has broadened the therapeutic arsenal, but it has also raised the complexity of choice for the treatment of type 2 diabetes mellitus (T2DM). The objective of this study was to systematically review the literature on economic evaluations associated with non-insulin antidiabetic drugs (NIADs) for T2DM.

METHODS

: The literature search was performed covering Medline, IBECS, Doyma and SciELO databases. We searched for full economic evaluations of NIADs in adults with T2DM applied after the failure of the first line of pharmacological treatment, published between 2010 and 2017 in Europe and North America (US and Canada). We focused on studies that incorporated quality adjusted life years. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An evaluation of the quality of the selected studies was carried out. The results were updated to euros of 2017.

RESULTS

: The review included a total of 57 studies, of which 134 comparisons were made between NIADs. The methodological quality of the studies was adequate. Under an acceptability threshold of 25,000 euros per QALY gained, SLGT-2i were preferable to DPP-4i and sulfonylureas in terms of incremental cost-utility. By contrast, there were no conclusive comparative results for the other two new NIAD groups (GLP-1 and DPP-4i).

CONCLUSIONS

: The heterogeneity of studies’ methodologies and results hindered our ability to determine under what specific clinical assumptions some NIADs would be more cost-effective than others. Economic evaluations should be used as part of the health decision-making process, therefore multifactorial therapeutic management strategies should be established based on the patients' clinical characteristics and preferences as principal criteria.