A Systematic Review of Cost-Effectiveness of Sodium-Glucose Cotransporter Inhibitors for Type 2 Diabetes

Purpose of review Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the most recently approved class of drugs (since 2012) for type 2 diabetes mellitus (T2DM), but their economic merits have yet been fully confirmed. The objective of this review was to evaluate the most updated evidence that examined the cost-effectiveness of SGLT2i for T2DM. Recent Findings We systematically searched Medline (PubMed), EMBASE, and Web of Science for eligible articles from January 1, 2011, to October 31, 2019, using combinations of search words. A supplementary search using reference lists of eligible articles and other review articles was also performed. A multistage screening process was carried out with duplicates removal, abstract screening, and full-text reading to confirm eligibility. Two reviewers independently screened the eligible articles and assessed reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. A total of 24 studies were included in the final review. All studies showed good quality according to the CHEERS checklist (scored 21-24). Seven studies compared SGLT2i vs. dipeptidyl peptidase-4 inhibitors (DPP-4i), 3 studies compared SGLT2i vs. sulfonylureas (SU), 3 compared SGLT2i vs. glucagon-like peptide-1 receptor agonist (GLP-1 RA), 2 compared SGLT2i vs. SGLT2i, 3 compared SGLT2i vs. other antidiabetic therapies including thiazolidinediones (TZD), alpha-glucosidase inhibitors (AGI) or insulin, and 5 compared SGLT2i vs. standard care/metformin. Most studies concluded SGLT2i was cost-effective relative to its comparator except GLP-1 RA, where two studies suggested GLP-1 RA was the favorable treatment option relative to SGLT2i. The literature demonstrated that SGLT2i may be cost-effective compared to many antidiabetic therapies including DPP-4i, SU, TZD, AGI, insulin, and standard care .