SGLT2 inhibitors provided more quality-adjusted life years at lower cost than GLP-1 receptor agonists for high-cardiovascular-risk type 2 diabetes patients in Canada, with GLP-1 drugs dominated in 62% of analyses.
$21,400/QALY vs DominatedSGLT2 inhibitors were consistently cost-effective while GLP-1 receptor agonists produced fewer benefits at higher cost in 62% of analyses
What the researchers found
Compared to baseline standard-of-care treatment, both drug classes improved outcomes:
- **SGLT2 inhibitors**: +0.24 QALYs, +$5,000 lifetime cost → $21,400 per QALY gained
- **GLP-1 receptor agonists**: +0.23 QALYs, +$27,000 lifetime cost → much higher cost per QALY
Both reduced lifetime rates of cardiovascular and renal events. However, SGLT2 inhibitors were consistently cost-effective in sensitivity analyses. In 62% of probabilistic sensitivity analysis iterations, GLP-1 RA were dominated — meaning they produced fewer QALYs at a higher cost than SGLT2 inhibitors. The authors noted GLP-1 RA cost-effectiveness could improve if benefits beyond typical diabetes complications (e.g., weight loss, dementia prevention) are considered and if generic formulations become available.
Why it matters
Healthcare budgets are finite, and both drug classes are expensive. This study provides Canadian policymakers and clinicians with crucial evidence for deciding between GLP-1 RA and SGLT2 inhibitors as first-line add-on therapy. The finding that SGLT2 inhibitors deliver comparable health benefits at dramatically lower cost ($5,000 vs $27,000 additional lifetime cost) could influence prescribing guidelines and drug coverage decisions in Canada and similar healthcare systems.
How the study worked
Patient-level microsimulation modeling lifetime costs, clinical events, and quality-adjusted life-years (QALYs). Initial characteristics were based on 216 patients from a Quebec clinic focused on initiating guideline-directed diabetes therapies (2022-2025). Risk equations and treatment effects were calibrated to endpoints from placebo-controlled cardiovascular outcome trials. Analysis used a Canadian healthcare payer perspective, lifetime horizon, and 1.5% annual discount rate. Probabilistic sensitivity analysis assessed robustness.
What this study cannot tell us
The model was based on 216 patients from a single Quebec clinic, which may not represent all Canadian diabetes patients. Treatment effects were derived from clinical trial populations that may not perfectly match real-world patients. The analysis did not include potential GLP-1 RA benefits beyond standard diabetes complications (weight loss effects, potential dementia prevention, liver disease improvement). Drug pricing is based on current Canadian costs and will change as patents expire.
How to read the evidence
This is a patient-level simulation study calibrated to real-world patient data and cardiovascular outcome trial results, published in CMAJ — Canada's leading medical journal. The probabilistic sensitivity analysis provides robust uncertainty assessment. However, results depend on modeling assumptions and current Canadian drug pricing.
When this study was published
Published in 2026 with patient data from 2022-2025, this is the most current Canadian cost-effectiveness comparison of GLP-1 RA versus SGLT2 inhibitors, reflecting recent pricing and clinical evidence.
The bigger picture
This study adds to growing health economic evidence questioning the value proposition of GLP-1 receptor agonists at current pricing — the same conclusion reached by obesity cost-effectiveness studies. While GLP-1 drugs offer clinically meaningful benefits, SGLT2 inhibitors achieve similar cardiovascular and renal outcomes at a fraction of the cost. As generic SGLT2 inhibitors enter the market and GLP-1 RA face pricing pressure, this economic landscape will shift, but the current analysis clearly favors SGLT2 inhibitors for value-conscious healthcare systems.
Questions still open
- Would including GLP-1 RA's weight loss benefits and emerging cardiovascular advantages change the cost-effectiveness conclusion?
- How will the introduction of generic GLP-1 receptor agonists affect this comparison?
- Should patients with specific comorbidity profiles (e.g., obesity + diabetes + cardiovascular disease) preferentially receive GLP-1 RA despite the cost premium?
Common questions
Should I take an SGLT2 inhibitor instead of a GLP-1 drug for my diabetes?
Why are GLP-1 drugs so much more expensive than SGLT2 inhibitors?
Read the original research
Cost-effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for patients with high cardiovascular risk and type 2 diabetes in Canada.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 198(7), E249-E259
Citation
McNally, Ethan S; Marques, Pedro; Possik, Elite; Pandya, Ankur; Tsoukas, Michael A; Mavrakanas, Thomas A; Dasgupta, Kaberi; Gupta, Nisha; Sharma, Abhinav; Russell, W Alton. (2026). Cost-effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for patients with high cardiovascular risk and type 2 diabetes in Canada.. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 198(7), E249-E259. https://doi.org/10.1503/cmaj.250591