Cost-effectiveness of dipeptidyl peptidase-4 inhibitors versus sulfonylureas as a second line therapy added to metformin in the treatment of type 2 diabetes mellitus in Turkey: a pharmacoeconomic study

Type 2 Diabetes Mellitus (T2DM) is a serious public health problem with a major cause of morbidity and mortality. As the population ages, the prevalence of T2DM continues to increase which leads to the development of new treatment technologies and medicines. Thus the health expenditures to treat T2DM is augmenting accordingly. As a result, in today's world, regulatory health authorities should develop strategies to address this staggering economic burden by introducing systematic cost-effectiveness evaluation among most recent innovative oral antidiabetics (OADs) with older treatment options while safeguarding the timely access of patients to optimum treatments. This study aimed to assess the cost-effectiveness of an innovative OAD class, dipeptidyl peptidase-4 inhibitors (DPP4is), with an older OAD class, sulfonylureas (SUs), as 2nd line therapy added to metformin in T2DM in Turkey. An event driven cost-effectiveness model developed with a 1 year time horizon with health care payer's perspective. Target T2DM population for the analysis calculated with data from literature. Direct costs of drug acquisition, screening, laboratory testing and costs of efficacy parameters included events of hypoglycemia, microvascular and macrovascular complications calculated. Incremental cost-effectiveness ratio was calculated as TL 2.779,82. Because the ICER value is below the ICER threshold of TL 45.463 per QALY gained, DPP4is estimated to be a cost-effective treatment alternative compared with SUs for the treatment of patients with T2DM.