Cost-effectiveness of dapagliflozin (Forxiga®) added to metformin compared with sulfonylurea added to metformin in type 2 diabetes in the Nordic countries

• Dapagliflozin – a sodium-glucose co-transporter 2 inhibitor working independently of insulin.
• Long term diabetes-related complications are estimated by a Cardiff simulation model.
• Data from a 52-week trial comparing dapagliflozin and SU in combination with metformin is used.
• Metformin + dapagliflozin is cost-effective vs. metformin + SU in Nordic type 2 diabetes patients.

AimsThe aim of this study was to assess the long-term cost-effectiveness of dapagliflozin (Forxiga®) added to metformin, compared with sulfonylurea (SU) added to metformin, in Nordic Type 2 diabetes mellitus (T2DM) patients inadequately controlled on metformin.MethodsData from a 52-week clinical trial comparing dapagliflozin and SU in combination with metformin was used in a Cardiff simulation model to estimate long term diabetes-related complications in a cohort of T2DM patients. Costs and QALYs were calculated from a healthcare provider perspective and estimated over a patient's lifetime.ResultsCompared with metformin + SU, the cost per QALY gained with dapagliflozin + metformin was €7944 in Denmark, €5424 in Finland, €4769 in Norway, and €6093 in Sweden. Metformin + dapagliflozin was associated with QALY gains ranging from 0.236 in Norway to 0.278 in Sweden and incremental cost ranging from €1125 in Norway to €1962 in Denmark. Results were robust across both one-way and probabilistic sensitivity analyses. Results were driven by weight changes associated with each treatment.ConclusionsResults indicate that metformin + dapagliflozin is associated with gains in QALY compared with metformin + SU in Nordic T2DM patients inadequately controlled on metformin. Dapagliflozin treatment is a cost-effective treatment alternative for Type 2 diabetes in all four Nordic countries.