Background: In recent years the prevalence of T2DM has been increasing. However, little consensus continues to exist on the matter of second line pharmacological treatment. The analysis intends to investigate the cost- effectiveness of treatment with SU, DPP-4i and GLP-1 on a drug class level in order to provide clarity on the subject. More over, a focus is put on the risk of hypoglycemia and the effect of weight change, which have been central arguments in the debate of therapy choice. Methods: A cost-utility analysis was carried out evaluating costs of therapy and quality of life associated with mild hypoglycemic incidences and weight change from pharmacological treatment of T2DM with DPP-4, SU and GLP- 1, in a 1-year Danish treatment setting. Data on incidence of hypoglycemia and weight change was derived from a comparison of 17 randomized control trials. Cost of therapy was based on Danish pharmacy prices. A decision analytic model was constructed using TreeAgePro and one-way - and probabilistic sensitivity analyses were carried out using 10.000 simulations. Results: In the base case analysis the cost of SU was 1427.59 Kr./year with an estimated 0,7734 QALY/patient. The DPP-4i had a cost of 5652,51 Kr./year with a value of 0,7871 QALY/patient. Finally the strategy of GLP-1 was 13052,18 Kr./year with 0,7944 QALY/patient. The SU proved most cost-effective type of therapy, however the result was sensitive to alterations WTP and QALY associated with weight change.
Conclusion: The analysis proved SU to be the most cost-effective choice of therapy at a WTP of 300.000 Kr. However, since the analysis only covers a 1-year treatment setting, long-term effects of especially SU should be taken into account. In addition it should be noted that no official Danish WTP exists and this parameter is important for the model-outcome.