Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies.

Bagepally BS, Chaikledkaew U, Gurav YK, Anothaisintawee T, Youngkong S, Chaiyakunapruk N, McEvoy M, Attia J, Thakkinstian A

BMJ open diabetes research & care1 Jul 2020Cited by 27 (Europe PMC)

PMID32690574PMCIDPMC7371226DOI10.1136/bmjdrc-2019-001020PepBankPUB-32690574

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Summary

ObjectivesTo conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.Research design and methodsThe study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost-utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I² statistic.ResultsA total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$-571.43 to US$8595.84, I²=0%), US$3857.34 (95% CI US$-7293.93 to US$15 008.61, I²=45.9%), US$37 577.74 (95% CI US$-649.02 to US$75 804.50, I²=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I²=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I²=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I²=0), respectively.ConclusionGLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs.Prospero registration numberCRD42018105193.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study6

2 results from studies that gave the peptide. 2 results from people.

01HumanSystematic reviewOther
In adults with type 2 diabetes after metformin failure, liraglutide was more cost-effective than lixisenatide.
In plain wordsIn adults with type 2 diabetes, liraglutide was better value than lixisenatide.
Peptide
Liraglutide
Outcome
IncreaseINB of liraglutide versus lixisenatide
Study
n: not reported in source
Comparator
Lixisenatide
Outcome group
Cost-effectiveness · Whole body
Studied dose
Dose not stated
Measurements
Pooled INB
4555.09 US$
liraglutide vs lixisenatide
Source sentences
Summary
Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I²=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I²=0), respectively.
1 context sentence(design, population, supporting numbers)
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
Show in the study text Report a problemFND-3269057405
02HumanSystematic reviewOther
In adults with type 2 diabetes after metformin failure, liraglutide was not significantly more cost-effective than exenatide.
In plain wordsIn adults with type 2 diabetes, liraglutide was not clearly better value than exenatide.
Peptide
Liraglutide
Outcome
No significant changeINB of liraglutide versus exenatide
Study
n: not reported in source
Comparator
Exenatide
Outcome group
Cost-effectiveness · Whole body
Studied dose
Dose not stated
Measurements
Pooled INB
728.46 US$
liraglutide vs exenatide
Source sentences
Summary
Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I²=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I²=0), respectively.
1 context sentence(design, population, supporting numbers)
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
Show in the study text Report a problemFND-3269057406

Studies that did not test the peptide alone4

In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Liraglutide.

03HumanNot a test of Liraglutide aloneSystematic reviewOther
In adults with type 2 diabetes after metformin failure, pooled GLP1 receptor agonists were not statistically significantly cost-effective compared with DPP4 inhibitors in high-income countries.
In plain wordsIn adults with type 2 diabetes, GLP1 drugs as a class were not clearly better value than DPP4 inhibitor drugs.
Peptide
Liraglutide
Outcome
No significant changePooled INB of GLP1 versus DPP4 inhibitors, high-income countries
Study
n: not reported in source
Comparator
DPP4 inhibitors
Outcome group
Cost-effectiveness · Whole body
Measurements
Pooled INB
4012.21 US$
GLP1 vs DPP4i, high-income countries
Source sentences
Summary
The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$-571.43 to US$8595.84, I²=0%)
2 context sentences(design, population, supporting numbers)
Summary · context
GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs.
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-3269057401
04HumanNot a test of Liraglutide aloneSystematic reviewOther
In adults with type 2 diabetes after metformin failure, pooled GLP1 receptor agonists were not statistically significantly cost-effective compared with sulfonylureas in high-income countries.
In plain wordsIn adults with type 2 diabetes, GLP1 drugs as a class were not clearly better value than sulfonylurea drugs.
Peptide
Liraglutide
Outcome
No significant changePooled INB of GLP1 versus sulfonylureas, high-income countries
Study
n: not reported in source
Comparator
Sulfonylureas
Outcome group
Cost-effectiveness · Whole body
Measurements
Pooled INB
3857.34 US$
GLP1 vs sulfonylureas, high-income countries
Source sentences
Summary
US$3857.34 (95% CI US$-7293.93 to US$15 008.61, I²=45.9%)
2 context sentences(design, population, supporting numbers)
Summary · context
GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs.
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-3269057402
05HumanNot a test of Liraglutide aloneSystematic reviewOther
In adults with type 2 diabetes after metformin failure, pooled GLP1 receptor agonists were not statistically significantly cost-effective compared with thiazolidinedione in high-income countries.
In plain wordsIn adults with type 2 diabetes, GLP1 drugs as a class were not clearly better value than thiazolidinedione drugs.
Peptide
Liraglutide
Outcome
No significant changePooled INB of GLP1 versus thiazolidinedione, high-income countries
Study
n: not reported in source
Comparator
Thiazolidinedione
Outcome group
Cost-effectiveness · Whole body
Source sentences
Summary
US$37 577.74 (95% CI US$-649.02 to US$75 804.50, I²=92.4%)
2 context sentences(design, population, supporting numbers)
Summary · context
GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs.
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-3269057403
06HumanNot a test of Liraglutide aloneSystematic reviewOther
In adults with type 2 diabetes after metformin failure, pooled GLP1 receptor agonists were statistically significantly cost-effective compared with insulins in high-income countries.
In plain wordsIn adults with type 2 diabetes, GLP1 drugs as a class were better value than insulin in high-income countries.
Peptide
Liraglutide
Outcome
IncreasePooled INB of GLP1 versus insulin, high-income countries
Study
n: not reported in source
Comparator
Insulin
Outcome group
Cost-effectiveness · Whole body
Source sentences
Summary
US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I²=86.4%)
2 context sentences(design, population, supporting numbers)
Summary · context
GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs.
Summary · context
To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure.
In this study, Liraglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Liraglutide.
Show in the study text Report a problemFND-3269057404

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 2Current
12 Oct 2026, 11:11 UTC
Study results updated
Version 1
9 Oct 2026, 03:05 UTC
First added · source update from Europe PMC

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