Cost-Effectiveness of Dapagliflozin Compared To Dpp-4 Inhibitors as Triple Therapy In Combination With Metformin and A Sulphonylurea In The Treatment Of Type 2 Diabetes Mellitus From A Uk Health Care Perspective.

„ Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that is characterised by raised blood glucose levels due to resistance to the action of insulin. „ T2DM represents a large clinical burden; approximately 2.9 million people were diagnosed with T2DM in 2013 in the UK,1 and treating T2DM and its complications is estimated to cost £12 billion annually.2 „ A step-wise approach to treatment is typically used alongside lifestyle changes, to help patients achieve target glycated haemoglobin (HbA1c) levels. First-line therapy is usually metformin (met), followed by adding on a sulphonylurea (SU) for second-line. Current third-line options to create a triple therapy regimen consist of either adding oral agents (dipeptidyl peptidase-4 inhibitors [DPP4i] or thiazolidinedione), or injectables (insulin or glucagon-like peptide-1 [GLP-1] analogues). „ Dapagliflozin belongs to the sodium-glucose co-transporter-2 (SGLT-2) inhibitor class, and acts by reducing glucose reabsorption from the proximal tubule of the kidney. Dapagliflozin was the first therapy in this novel class of insulin-independent, glucose-lowering medications. „ Dapagliflozin at 10 mg once daily is licensed for the treatment of adults aged 18 years and older with T2DM to improve glycaemic control when used in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. „ Dapagliflozin was accepted by the Scottish Medicines Consortium (SMC) for use in triple therapy in combination with met+SU, as an alternative to a DPP4i, on the basis of the costeffectiveness analysis presented below.