Are Newer Diabetes Drugs Worth the Long-Term Cost Globally?

The global prevalence of Type 2 Diabetes Mellitus (T2DM) continues to rise, posing a significant public health challenge and economic burden. The introduction of newer antidiabetic drugs, such as GLP-1 receptor agonists and SGLT2 inhibitors, has revolutionized treatment by offering superior glycemic control and cardiovascular benefits. However, their higher acquisition costs raise questions about their overall value, creating a critical need to systematically evaluate the long-term cost-effectiveness of these newer antidiabetic drugs across diverse healthcare systems.

The review found that newer antidiabetic drugs, despite higher initial costs, frequently demonstrated long-term cost-effectiveness due to reduced complications. GLP-1 receptor agonists showed an average Incremental Cost-Effectiveness Ratio (ICER) of $25,000 per Quality-Adjusted Life Year (QALY) in high-income countries, which is well below the commonly accepted $50,000/QALY willingness-to-pay threshold. SGLT2 inhibitors were found to be cost-effective in 65% of the included studies, primarily driven by significant reductions in cardiovascular (CV) and renal events, leading to cost savings over a 10-year horizon in 40% of analyses. The most significant finding was that while initial acquisition costs are higher, newer antidiabetic drugs often become cost-effective over a 5-10 year horizon due to reduced complications, with GLP-1 receptor agonists showing the most consistent long-term value across various healthcare settings. Conversely, DPP-4 inhibitors generally exhibited lower cost-effectiveness compared to GLP-1 receptor agonists and SGLT2 inhibitors in preventing major adverse cardiovascular events, achieving cost-effectiveness in only 35% of studies.