To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics.
Three investigators searched the CRD York, Tufts CEA Registry, and MEDLINE databases through 2015. We reviewed all potentially relevant titles and abstracts, and screened full-text articles, according to inclusion criteria. We established a quality score for each study based on a 35-item list.
A total of 295 studies were identified, of which 20 were included. The average quality score was 0.720 on a 0–1 scale. All studies were performed in high- and middle-income countries, using a 3rd-party payer perspective and randomized clinical trials to measure effectiveness. Sitagliptin, saxagliptin and vildagliptin had an ICER below 25,000 €/QALY, as second-line and as add-ons to metformin, in comparison to sulfonylureas. When compared with sitagliptin, liraglutide (GLP-1 receptor agonist) had an ICER of up to 22,724 €/QALY for the 1.2-mg dosage, and up to 32,869 €/QALY for the 1.8-mg dosage. Insulin glargine was dominant when compared with sitagliptin.
According to the WHO threshold applied to the country and year of each study, DPP-4 inhibitors were highly cost-effective as second-line, as add-ons to metformin, in comparison with sulfonylureas. More recent therapies (GLP-1 receptor agonists and insulin glargine) were highly cost-effective in comparison to DPP-4 inhibitors. These results were obtained, however, on the basis of a limited number of studies, relying on the same few clinical trials, and financed by manufacturers. Further independent research is needed to confirm these findings.
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This research had no external funding.
Conflict of interest
The authors declare that they have no conflict of interest. The authors have no affiliations or financial involvement that conflicts with the material presented in this paper. The authors are not employed in the pharmaceutical industry and, at the time of this research, had not performed nor were conducting any research study pertaining to the DPP-4 inhibitors group, nor were conducting any research for any of the marketing authorization holders of those therapeutic agents.
See Table 3.
Template for each study extracted and recorded information:
Title [incl. author(s) and journal]
Type of economic evaluation
Methods (Analytical approach; Perspective; Time Horizon; Population; Effectiveness data; Monetary benefit and utility valuation; Measure of benefit; Cost data; Discount rate; Analysis of uncertainty)
Affiliation to pharmaceutical industry
Search strings for search:
Sitagliptin OR Saxagliptin OR Vildagliptin OR Alogliptin OR Linagliptin assessed in March 2015
Sitatgliptin AND Saxagliptin assessed in March 2015
Sitagliptin AND Vildagliptin assessed in March 2015
Sitagliptin AND Alogliptin assessed in March 2015
Sitagliptin AND Linagliptin assessed in March 2015
Saxagliptin AND Vildagliptin assessed in March 2015
Saxagliptin AND Alogliptin assessed in March 2015
Saxagliptin AND Linagliptin assessed in March 2015
Vildagliptin AND Alogliptin assessed in March 2015
Vildagliptin AND Linagliptin assessed in March 2015
Alogliptin AND Linagliptin assessed in March 2015
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Baptista, A., Teixeira, I., Romano, S. et al. The place of DPP-4 inhibitors in the treatment algorithm of diabetes type 2: a systematic review of cost-effectiveness studies. Eur J Health Econ 18, 937–965 (2017). https://doi.org/10.1007/s10198-016-0837-7
- Cost-effectiveness studies
- DPP-4 inhibitors
- Systematic review