Cost-effectiveness of dapagliflozin versus sulfonylurea in combination with metformin in patients with type 2 diabetes in Vietnam: Analysis from the Payer’s Perspective

Tóm tắt

Type 2 diabetes mellitus (T2DM) poses a substantial economic burden on both patients and healthcare systems. Dapagliflozin, an SGLT2 inhibitor, has shown effective glycemic control and reduced risk of hypoglycemia in T2DM patients; however, its higher treatment cost compared with other antidiabetic agents raises concerns about its economic value. This study assessed the cost-effectiveness of dapagliflozin versus sulfonylurea, both in combination with metformin, in patients with T2DM inadequately controlled on metformin monotherapy, from the Vietnamese healthcare payer’s perspective over a lifetime horizon. A model-based cost-utility analysis using the Cardiff Diabetes Model—a patient-level microsimulation—was conducted. Results indicated that dapagliflozin reduced the cumulative incidence of complications, particularly hospitalization for heart failure and chronic kidney disease. The incremental cost and quality-adjusted life-years (QALYs) gained with dapagliflozin were estimated at 15,941,900 VND and 0.52 QALY, respectively, yielding an incremental cost-effectiveness ratio (ICER) of 30,865,504 VND/QALY, well below Vietnam’s per capita GDP threshold (~114.2 million VND in 2024). Sensitivity analyses confirmed the robustness of these findings, with dapagliflozin remaining cost-effective across various assumptions. In conclusion, dapagliflozin is a cost-effective and clinically beneficial alternative to sulfonylurea as a first-line therapy in Vietnam, supporting its inclusion in reimbursement schemes and clinical practice guidelines for long-term T2DM management.