Examining the U.S. Cost-Effectiveness of Alternative Glycemic Treatment Algorithms in the Era of New Medications


Given the substantial economic burden of diabetes, it is important to understand the economic value of diabetes treatment. In the past, intensive glycemic control with available glucose-lowering medications (i.e., metformin, sulfonylureas, and insulin) was found to be cost-effective compared to conventional control. Since, diabetes has been transformed by the arrival of two medication classes: 1) glucagon-like peptide-1 receptor agonists (GLP1RAs) and 2) sodium-glucose cotransporter-2 inhibitors (SGLT2Is). Although these new agents have not been more effective at directly lowering glucose compared to older drugs, they have been found to reduce cardiovascular (CV) risk factors, CV outcomes, and mortality in patients with high CV disease risk. While the landscape of medications has been rapidly changing, treatment algorithms from the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and others have been largely unchanged. Currently, guidelines do not endorse GLP1RAs and SGLT2Is over older treatment options because all diabetes classes lower A1C to the same degree while having important differences in side effects and costs. This study will be the first economic evaluation of GLP1RAs and SGLT2Is that accounts for their clinical benefits and future decline in cost.


The aim of this project is to accelerate the understanding of the economic value of prioritizing GLP1RAs and SGLT2Is in the ADA/EASD diabetes medication protocols. Further, it will be able to provide important information on the value of these newer classes of diabetes medications for clinical thought leaders and insurers and potentially change the recommendations of diabetes management medication algorithms.

Specific Aims:

Aim 1:

To quantify the CV risk factor, CV outcome, and mortality effects of GLP1RAs and SGLT2Is versus other existing agents in clinical trial data using network meta-analysis.

Aim 2:

To revise the U.S. Type 2 Diabetes Policy Model to account for the unique CV risk factor, CV outcome, and mortality effects, and future costs of GLP1RAs and SGLT2Is.

Aim 3:

To determine the cost-effectiveness of alternative diabetes medication protocols, which elevate the role of GLP1RAs and SGLT2Is, compared to the ADA/EASD treatment algorithm.

3A: To test GLP1RAs and SGLT2Is as second-line agents as add-ons to metformin compared to other classes of diabetes medications

3B: To test GLP1RAs and SGLT2Is as first-line agents compared to metformin.


Principal Investigator: Neda Laiteerapong, MD, MS, University of Chicago

Research Team:

Jason Alexander, MD, University of Chicago

Melissa Franco, MPH, University of Chicago

Elbert Huang, MD, University of Chicago

Louis Philipson, MD, PhD, University of Chicago

Erin Staab, MPH, University of Chicago

Celeste Thomas, MD, MS, University of Chicago

Wen Wan, PhD, University of Chicago

Shari D. Bolen, MD, MPH, Case Western Reserve University

Nisa M. Maruthur, MD, Johns Hopkins

M. Reza Skandari, PhD, Imperial College London

Aaron Winn, PhD, MPP, Medical College of Wisconsin


Funding Source:

American Diabetes Association (1-18-JDF-037-Laiteerapong)