{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T02:59:00Z","timestamp":1776135540071,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,9,18]],"date-time":"2020-09-18T00:00:00Z","timestamp":1600387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>When glycaemic control for people with type 2 diabetes is not achieved with metformin and sulfonylurea alone, adding another oral anti\u2010diabetes drug, such as a sodium\u2013glucose co\u2010transporter 2 (SGLT2) or dipeptidyl peptidase\u20104 (DPP\u20104) inhibitor, is an alternative to starting insulin. The aim of this study is to determine the cost\u2010effectiveness of dapagliflozin (an SGLT2 inhibitor) compared with DPP\u20104 inhibitors when added to metformin and sulfonylurea in people with type 2 diabetes in the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cost\u2013utility analysis is performed using the Cardiff diabetes model, a fixed\u2010time increment stochastic simulation model informed by \u2018United Kingdom Prospective Diabetes Study 68\u2019 risk equations. The base\u2010case analysis uses a 40\u2010year time horizon, a Dutch societal perspective and differential discounting (4% for costs, 1.5% for effects). Inputs are obtained from the literature and Dutch price lists. Univariate and probabilistic sensitivity analysis are performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Dapagliflozin is dominant compared with DPP\u20104 inhibitors, resulting in a \u20ac990 cost saving and a 0.28 quality\u2010adjusted life year gain over 40\u00a0years. Cost savings are associated mainly with treatment costs and a reduced incidence of micro\u2010 and macrovascular complications, among others nephropathy, myocardial infarction and stroke. Results are robust to changes in input parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Dapagliflozin is a cost\u2010saving alternative to DPP\u20104 inhibitors when added to metformin and sulfonylurea. The incidence of micro\u2010 and macrovascular complications is lower for people treated with dapagliflozin. Uncertainty around this outcome is low.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14371","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T21:17:37Z","timestamp":1596489457000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The cost\u2010effectiveness of dapagliflozin compared to DPP\u20104 inhibitors in the treatment of type 2 diabetes mellitus in the Netherlands"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1646-9834","authenticated-orcid":false,"given":"N.","family":"Van der Linden","sequence":"first","affiliation":[{"name":"Market Access Department AstraZeneca The Hague the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Van Olst","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management Erasmus University Rotterdam the Netherlands"},{"name":"Real\u2010World and Analytics Solutions IQVIA Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Nekeman","sequence":"additional","affiliation":[{"name":"Market Access Department AstraZeneca The Hague the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.A.","family":"Uyl\u2010de Groot","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; 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