• Eduardo José Abad Paniagua, Pedro Casado Escribano, José María Fernández Rodriguez, Francisco J Morales Escobar, Lourdes Betegón Nicolás, Joaquín Sánchez-Covisa, and Max Brosa.
• Centro de Salud Las Águilas, Madrid, España.
• Aten Primaria. 2015 Oct 1; 47 (8): 505-13.

ObjectiveTo assess the efficiency of the combined therapy with metformin and dapagliflozin, a new oral anti-diabetic drug with an insulin-independent mechanism of action, in the treatment of type-2 diabetes mellitus (T2DM) compared to DPP4 inhibitors, sulphonylureas and thiazolidindiones, also combined with metformin.DesignCost-effectiveness analysis using a discrete event simulation model based on the results of the available clinical trials and considering patient's entire life as time horizon.SettingNational Health System perspective.ParticipantsThe model simulated the natural history of 30,000 patients with T2DM for each of the options compared.Main MeasurementsQuality-adjusted life-years (QALY) and economic consequences of managing the disease and its complications. The analysis considered direct costs updated to 2013. A discount rate of 3% was applied to costs and health outcomes.ResultsIn the main analysis comparing dapagliflozin with DPP4 inhibitors, dapagliflozin resulted in a treatment option that would provide a slightly higher effectiveness (0.019 QALY) and lower overall associated costs (-€42). In the additional analyses, dapagliflozin was a cost-effective option compared with sulphonylureas and thiazolidinediones resulting in a cost per QALY gained of €3,560 and €2,007, respectively. The univariate and probabilistic sensitivity analyses confirmed the robustness of the results.ConclusionsThe results of the analyses performed suggested that dapagliflozin, in combination with metformin, would be a cost-effective alternative in the Spanish context for the treatment of T2DM.Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

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