A Systematic Review: Cost-Effectiveness of SGLT2 Inhibitors versus DPP-4 Inhibitors as Add-on to Metformin
Abstract
Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are two second-line therapy alternatives for T2DM patients inadequately controlled with metformin. Objective: This study aimed to systematically review the cost-effectiveness of combining metformin+SGLT2i vs metformin+DPP-4i for T2DM treatment. Methods: A systematic search was conducted in PubMed, Scopus, and ScienceDirect for articles published between 2015-2025, using predefined keywords and following the PRISMA and PICOS frameworks (P: T2DM patients uncontrolled on metformin monotherapy; I: Metformin+SGLT2i therapy; C: Metformin+DPP-4i therapy; O: Cost, clinical outcomes (HbA1c% reduction), Incremental Cost-Effectiveness Ratio (ICER) values, Quality Adjusted Life Years (QALY); S: Study with cost-effectiveness analysis design). Additional studies were identified through reference screening. Eligible articles were independently reviewed and assessed for reporting quality using the CHEERS-2022 standards. Results: Five studies met the inclusion criteria. Considerable heterogeneity was observed with mean patient ages ranging from 55-61 years old and baseline HbA1c levels from 7.9%-9.4%. The studies were conducted in the US, UK, Mexico, and Greece, all funded by the pharmaceutical industry, and used economic models. Despite these differences, all studies consistently demonstrated that combining…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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