Pharmacoeconomic evaluation of dipeptidyl peptidase-4 inhibitors for the treatment of type 2 diabetes mellitus: a systematic literature review

ABSTRACT

Introduction

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used oral antidiabetic agents that exert antihyperglycemic effects in type 2 diabetes mellitus (T2DM) without increased risk of weight gain or hypoglycemic events. The objective of this paper was to systematically review the latest evidence that was associated with the pharmacoeconomic evaluation of DPP-4i for the treatment of patients with T2DM.

Areas covered

We conducted a systematic literature search of eligible articles published since inception up to March 2021 in Web of Science, MEDLINE (via PubMed), and ECONLIT. Fifty-four eligible articles were included in our review, in which DPP-4i were compared to metformin (4 studies), sulphonylurea (SU) (16 studies), alpha-glucosidase inhibitors (AGI) (3 studies), thiazolidinediones (TZD) (4 studies), other DPP-4i (3 studies), sodium-glucose co-transporter-2 inhibitors (SGLT-2i) (10 studies), glucagon-like peptide 1 receptor agonist (GLP-1RA) (18 studies), insulin (5 studies), and other antidiabetic therapies (5 studies).

Expert opinion

This study provided the updated evidence of systematic pharmacoeconomic evaluation associated with DPP-4i for the treatment of patients with T2DM. The evidence from the literature suggested that DPP-4i may be more cost-effective compared to SU and insulin as second-line therapy after metformin but not a cost-effective alternative compared to SGLPT-2i and GLP-1RA.

KEYWORDS:

• Type 2 diabetes mellitus
• Dipeptidyl peptidase-4 inhibitors
• DPP-4i
• pharmacoeconomic
• cost-effectiveness
• systematic review

Article highlight

• Dipeptidyl peptidase-4 inhibitors (DPP-4i) are new oral antidiabetic agents used for T2DM treatment. This systematic review examined the most recent peer-reviewed pharmacoeconomic evaluation studies that focused on DPP-4i.

• In T2DM patients who are not controlled with metformin therapy, DPP-4i as a second-line treatment may be a cost-effective option compared to sulphonylurea (SU) and insulin.

• However, DPP-4i added-on to metformin are not cost-effective compared to newer anti-diabetic drugs, including sodium-glucose co-transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide 1 receptor agonist (GLP-1RA). Furthermore, DPP-4i monotherapy is not cost-effective compared to metformin monotherapy for T2DM treatment.

• The cost-effectiveness of DPP-4i compared with TZD and AGI still remains uncertain. It is also uncertain which agent is the most cost-effective DPP-4i.

• This information will be of great use to health policy-makers and clinicians, as well as patients living with T2DM.

Acknowledgments

The authors are grateful to the editor and the reviewers for their helpful comments and constructive suggestions regarding the revision of the paper.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Z Ruan and H Hu made the research strategy; H Zou and Q Lei performed the systematic literature search; Z Ruan, H Zou, and Q Lei contributed to the data collection, Z Ruan, H Zou, and Q Lei performed the data analysis and interpretation of data; Q Lei and H Zou performed the reporting quality assessment; Z Ruan, H Zou, Q Lei, and H Shi contributed to the manuscript writing; C Ung and H Hu revised the manuscript; and all the authors reviewed and approved the final vision.

Additional information

Funding

This paper was not funded.