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Diabetes Obes Metab. 2020 Feb 9. doi: 10.1111/dom.13992. [Epub ahead of print]

Cost-effectiveness of dapagliflozin as an adjunct to insulin for the treatment of Type 1 Diabetes Mellitus in the UK.

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Health Economics and Outcomes Research Ltd, Cardiff, UK.
Global Market Access & Pricing, Cambridge, UK.
Department of Medicine, University Hospital Llandough, Cardiff, UK.
Global Market Access & Pricing, Gothenburg, Sweden.



The aim was to assess the cost-effectiveness of dapagliflozin (an SGLT-2 inhibitor) as an adjunct to insulin in adults with type 1 diabetes mellitus (T1DM) inadequately controlled by insulin alone in the UK setting.


A cost-utility analysis compared dapagliflozin (5 mg or 10 mg) added to insulin versus insulin monotherapy (standard of care) over a lifetime horizon. Treatment efficacy and safety parameters were obtained from 52-week results of the DEPICT-1 and DEPICT-2 trials and a network meta-analysis of SGLT-2 inhibitors in T1DM. Direct healthcare costs, life years, and quality-adjusted life years (QALYs) were estimated from a UK payer perspective and discounted at 3.5% annually, using the Cardiff T1DM Model. Sensitivity analyses assessed uncertainty in estimated incremental cost-effectiveness ratios (ICERs).


Dapagliflozin 5 mg was associated with gains of 0.23 life years and 0.42 QALYs, at an additional cost of £4,240 per person; corresponding to an ICER of £10,143 versus standard of care. For dapagliflozin 10 mg, incremental life years, QALYs and costs were 0.24, 0.49 and £2,964, respectively; corresponding to an ICER of £6,103 versus standard of care. In probabilistic sensitivity analysis, ICER estimates fell below £20,000/QALY in 78%-90% of simulations. Cost-effectiveness results were sensitive to changes in baseline patient characteristics and treatment effects on HbA1c; however, ICERs remained below £20,000.


At cost-effectiveness thresholds conventionally applied in the UK, dapagliflozin as an adjunct to insulin appears to be a cost-effective treatment option for people with T1DM inadequately controlled by insulin alone. This article is protected by copyright. All rights reserved.


Diabetes MellitusType 1; cost-effectiveness; dapagliflozin; insulin


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