Background: Dapagliflozin is a potential for combination therapy with metformin in T2DM. However, its cost-effectiveness relative to other alternatives in the Israeli healthcare setup remains unknown.

Objective: To evaluate the cost-effectiveness of dapagliflozin 10mg as add-on to metformin, compared to common alternatives (sitagliptin 100mg, glimepiride 2mg, liraglutide 1.2mg) based on Meuhedet health services database.

Methods: A cost-effectiveness evaluation was performed using the Cardiff diabetes model. A cohort of 1000 T2DM patients (ages 21 and older) who had received additional medication to metformin was randomly chosen from Meuhedet’s database. Baseline values for demographic and clinical variables prior to the add-on therapy, along with data from clinical trials served as inputs to the model. Simulation was performed for each drug, calculating its total costs and benefits (QALYs). The model’s time horizon was set to 40 years, annual discount rate for both costs and benefits was 3.5% and incremental cost effectiveness ratio (iCER) threshold was £20,000/QALY. Finally, single-variable and multivariable sensitivity analyses were performed.

Results: In the base-case scenario, dapagliflozin was found cost-effective compared to sitagliptin, liraglutide and glimepiride (iCER values of £1,232, £-16,517 and £13,476, respectively). For all comparisons, iCER was driven by differences in costs, while differences in QALYs were minimal. Dapagliflozin remained cost-effective even after performing sensitivity analyses. However, when performing the simulation under comparators’ generic competition scenario, dapagliflozin was no longer cost-effective compared to liraglutide (iCER =£24,900/QALY).

Conclusion: Dapagliflozin as add-on treatment to metformin was cost-effective compared to several alternatives in T2DM patients in Israel’s healthcare system. Additional research is needed in order to evaluate the effects of evolving new clinical data.


S. Moshel: Research Support; Self; AstraZeneca. M. Hirsch Vexberg: None. O. Shavit: None. Y. Toledano: None.

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