Cost-effectiveness of dapagliflozin (Forxiga®) added to metformin compared with sulfonylurea added to metformin in type 2 diabetes in the Nordic countries

Prim Care Diabetes. 2015 Feb;9(1):39-47. doi: 10.1016/j.pcd.2014.04.007. Epub 2014 May 17.


Aims: The aim of this study was to assess the long-term cost-effectiveness of dapagliflozin (Forxiga(®)) added to metformin, compared with sulfonylurea (SU) added to metformin, in Nordic Type 2 diabetes mellitus (T2DM) patients inadequately controlled on metformin.

Methods: Data from a 52-week clinical trial comparing dapagliflozin and SU in combination with metformin was used in a Cardiff simulation model to estimate long term diabetes-related complications in a cohort of T2DM patients. Costs and QALYs were calculated from a healthcare provider perspective and estimated over a patient's lifetime.

Results: Compared with metformin+SU, the cost per QALY gained with dapagliflozin+metformin was €7944 in Denmark, €5424 in Finland, €4769 in Norway, and €6093 in Sweden. Metformin+dapagliflozin was associated with QALY gains ranging from 0.236 in Norway to 0.278 in Sweden and incremental cost ranging from €1125 in Norway to €1962 in Denmark. Results were robust across both one-way and probabilistic sensitivity analyses. Results were driven by weight changes associated with each treatment.

Conclusions: Results indicate that metformin+dapagliflozin is associated with gains in QALY compared with metformin+SU in Nordic T2DM patients inadequately controlled on metformin. Dapagliflozin treatment is a cost-effective treatment alternative for Type 2 diabetes in all four Nordic countries.

Keywords: Cost-effectiveness; Dapagliflozin; Economic modeling; Sulfonylurea; Type 2 diabetes mellitus.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benzhydryl Compounds / adverse effects
  • Benzhydryl Compounds / economics*
  • Benzhydryl Compounds / therapeutic use*
  • Computer Simulation
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Drug Costs*
  • Drug Therapy, Combination
  • Glucosides / adverse effects
  • Glucosides / economics*
  • Glucosides / therapeutic use*
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / economics*
  • Hypoglycemic Agents / therapeutic use*
  • Metformin / adverse effects
  • Metformin / economics*
  • Metformin / therapeutic use*
  • Models, Economic
  • Quality-Adjusted Life Years
  • Scandinavian and Nordic Countries / epidemiology
  • Sulfonylurea Compounds / adverse effects
  • Sulfonylurea Compounds / economics*
  • Sulfonylurea Compounds / therapeutic use*
  • Time Factors
  • Treatment Outcome


  • Benzhydryl Compounds
  • Glucosides
  • Hypoglycemic Agents
  • Sulfonylurea Compounds
  • dapagliflozin
  • Metformin