Cost-effectiveness of Canagliflozin versus Sitagliptin When Added to Metformin and Sulfonylurea in Type 2 Diabetes in Canada

J Popul Ther Clin Pharmacol. 2016;23(2):e151-68. Epub 2016 Jul 15.


BackgroundCanagliflozin, an agent that inhibits sodium glucose co-transporter 2, is approved as add-on to metformin plus sulfonylurea for the treatment of type 2 diabetes in Canada. Canagliflozin offers greater glycemic control, as well as important additional benefits such as weight loss and blood pressure reductions, versus dipeptidyl peptidase-4 inhibitors such as sitagliptin. ObjectiveThis analysis evaluated the cost-effectiveness of canagliflozin 300 mg and canagliflozin 100 mg versus sitagliptin 100 mg in patients with type 2 diabetes inadequately controlled on metformin plus sulfonylurea from the perspective of the Canadian Agency for Drugs and Technologies in Health. MethodsA 40-year cost-effectiveness analysis was performed using the validated Economic and Health Outcomes Model of Type 2 Diabetes Mellitus (ECHO-T2DM). Patient characteristics, treatment effects, and rates of hypoglycemia and adverse events were sourced from the canagliflozin clinical program. Canada-specific costs and utilities were applied. Sensitivity analyses were conducted using alternative values for key model inputs. ResultsBoth canagliflozin 300 and 100 mg dominated sitagliptin 100 mg over 40 years, providing quality-adjusted life-year gains of 0.31 and 0.28, and cost offsets of $2,217 and $2,560, respectively. Both canagliflozin doses dominated sitagliptin in each of the sensitivity analyses. ConclusionsSimulation results suggested that canagliflozin 300 and 100 mg provided better health outcomes and lower costs than sitagliptin 100 mg as a third-line therapy added-on to metformin and sulfonylurea in patients with type 2 diabetes in Canada.

MeSH terms

  • Aged
  • Blood Glucose
  • Canada
  • Canagliflozin / economics*
  • Canagliflozin / therapeutic use
  • Cost-Benefit Analysis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Dipeptidyl-Peptidase IV Inhibitors / economics
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Glycated Hemoglobin
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemic Agents / economics*
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Metformin / economics
  • Metformin / therapeutic use
  • Middle Aged
  • Models, Econometric
  • Quality-Adjusted Life Years
  • Sitagliptin Phosphate / economics*
  • Sitagliptin Phosphate / therapeutic use
  • Sodium-Glucose Transporter 2 Inhibitors
  • Sulfonylurea Compounds / economics
  • Sulfonylurea Compounds / therapeutic use


  • Blood Glucose
  • Dipeptidyl-Peptidase IV Inhibitors
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors
  • Sulfonylurea Compounds
  • Canagliflozin
  • Metformin
  • Sitagliptin Phosphate