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All Journal MPI (Media Pharmaceutica Indonesiana) JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA JMM (Jurnal Masyarakat Mandiri) Manuju : Malahayati Nursing Journal JFIOnline Journal of Telenursing (JOTING) Jurnal Ilmiah Ibnu Sina (JIIS): Ilmu Farmasi dan Kesehatan Jurnal Farmasi Komunitas Linggau Journal Science Education (LJSE) Jurnal Bakti Untuk Negeri Journal of Public Health and Pharmacy Borneo Journal of Pharmacy
Yunita Nita
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Chemistry Dentistry Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Materials Science & Nanotechnology Medicine & Pharmacology Nursing Public Health Other

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Journal : JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA

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A Systematic Review: Cost-Effectiveness of SGLT2 Inhibitors versus DPP-4 Inhibitors as Add-on to Metformin Hanifiyah, Izzatu Al; Nita, Yunita; Libriansyah; Ridwan, Achmad
JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA Vol. 12 No. 2 (2025): JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jfiki.v12i22025.256-263

Abstract

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are two second-line therapy alternatives for T2DM patients inadequately controlled with metformin. Objective: This study aimed to systematically review the cost-effectiveness of combining metformin+SGLT2i vs metformin+DPP-4i for T2DM treatment. Methods: A systematic search was conducted in PubMed, Scopus, and ScienceDirect for articles published between 2015-2025, using predefined keywords and following the PRISMA and PICOS frameworks (P: T2DM patients uncontrolled on metformin monotherapy; I: Metformin+SGLT2i therapy; C: Metformin+DPP-4i therapy; O: Cost, clinical outcomes (HbA1c% reduction), Incremental Cost-Effectiveness Ratio (ICER) values, Quality Adjusted Life Years (QALY); S: Study with cost-effectiveness analysis design). Additional studies were identified through reference screening. Eligible articles were independently reviewed and assessed for reporting quality using the CHEERS-2022 standards. Results: Five studies met the inclusion criteria. Considerable heterogeneity was observed with mean patient ages ranging from 55-61 years old and baseline HbA1c levels from 7.9%-9.4%. The studies were conducted in the US, UK, Mexico, and Greece, all funded by the pharmaceutical industry, and used economic models. Despite these differences, all studies consistently demonstrated that combining metformin+SGLT2i was more cost-effective than metformin+DPP-4i. SGLT2i improved the quality of life by 0.032–0.04 QALYs, reduced hypoglycemia, and provided additional benefits for patients with cardiovascular risk, although it was associated with higher initial costs. Conclusion: This review showed that the combination of metformin+SGLT2i was more cost-efficient and effective in managing T2DM than the combination of metformin+DPP-4i.
Co-Authors Abdul Rahem Abdul Rahem, Abdul Achmad Ridwan, Achmad Adinda Siti Almirah Fatima Alfiana Istighfarin Amanda, Natasya Noor Ana Yuda Ananda Indzar Kholilah Ananda, Yussi Anatasya Andini Setiawan Andi Hermansyah Angelica Kresnamurti Aprilia Purwita Arie Sulistyarini As Sulton, Alfiansyah Maulana Aswarliansyah Ayu Dewi Sartika Bambang Subakti Z Byandra, Naila Devita Ivana Putri Diamita, Bernardina Dihan Asnafin Fadhila Dina Syauqina Hamid Dinara Fathya Rahma P Ditha Carolina Emanuella Elian Haris Darmawan Elida Zairina Fauziyyah Labibah Firdaus, Favian Rafif Gamar, Fahmi Haitsami Ibnu Gesnita Nugraheni Gusti Noorrizka V Hamidah, Nabilah Nur Hanifiyah, Izzatu Al Hasna, Safina Hanifa Hermansyah, Andi I NYOMAN WIJAYA Ihda Nuril Fitriani Iim Suhaemi, Iim Ike Septi Marinda Indah Pratiwi Aryani Kevin Hermawan Hutahaean Kristiani, Ananda Dwi Laras, Kirana Sekar Libriansyah M Aqbil Izzul Haq Mahanggi, Oktarina Maldini, Cindy Andrifo Marensa Faradilla Mareta Rindang Andarsari Marita Belia Putri Muhammad Rizky Nadilah Sobrina Zakiroh Nafi' Nur Hidayah Nafisah Putri Syaharani Najmi MY. Tunggeng Nasywa Ekgi Cahyani Ningsih, Sulistiya Noor Baihaqi, Reihan Ananta Noorrizka, Gusti Nova, Hikmah Octavia, Devi Ristian Pratiwi, Kusma Ayu Priyandani, Yuni Purwitasari, Neny Puspitasari, Hanni Prihhastuti Putri Anggi Aprilia Marcelina Putri, Fida Roesdiana Putri, Sonia Anggitha Rahmawati, Diana Aulia Ridzhan Mawasa Riza Alfian Rokayah Rokayah Rosinta Dewi Anggraeni Sapna Rizka Salsabila Sari, Febrina Kurnia SETIAWAN, Catur Dian Setyawan, Rr. Elmira Sidiq, Kadavi Arafat Silalahi, Zavirah Suhaemi, Iim Talitha Danendra Putri Tsabita, Irdandia Maitsa Tyrzaurra Amalya Maharani Umi Athiyah Umi Athiyah, Umi Virly Natalia Wahyuningtyas, Afifah Rahma Wardhani, Dewanti Wijaya, Aurellia Chance Yuni Priyandani Za'im Hanif Al Fathoni Zahrani, Nafisah Zakiyya, Reyhana Rona