Dapagliflozin for the management of type 2 diabetes 21/8/2013
Decision Summary Date of DTG DTG Decision Date of LAPC Traffic Light List Date of funding Funding decision Commissioning Other considerations
• Dapagliflozin is a sodium-glucose co-transporter-2 inhibitor, which blocks reabsorption of glucose by the
kidneys, licensed for use in adults over 18 with type 2 diabetes mellitus to improve glycaemic control.
• Dapagliflozin has been considered in NICE TA288. The application is for use in line with this guidance.
• The endocrinology team do not anticipate starting a significant number of patients on this product - it is thought
that the majority of initiation will take place in primary care
• The cost across Leeds is estimated by NICE to be approximately £188,000 per year. The costs to LTHT will be
due to patients being admitted on the product. Because of this, it is not possible to estimate LTHT costs, or the particular CSUs which will be affected.
Place in therapy / pathway As per NICE TA288: 1.1 Dapagliflozin in a dual therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if it is used as described for dipeptidyl peptidase-4 (DPP-4) inhibitors in Type 2 diabetes: the management of type 2 diabetes (NICE clinical guideline 87). 1.2 Dapagliflozin in combination with insulin with or without other antidiabetic drugs is recommended as an option for treating type 2 diabetes. 1.3 Dapagliflozin in a triple therapy regimen in combination with metformin and a sulfonylurea is not recommended for treating type 2 diabetes, except as part of a clinical trial. 1.4 People currently receiving dapagliflozin in a dual or triple therapy regimen that is not recommended for them in 1.1 or 1.3 should be able to continue treatment until they and their clinician consider it appropriate to stop. From NICE CG87: 18.104.22.168 Consider adding a DPP-4 inhibitor instead of a sulfonylurea as second-line therapy to first-line metformin when control of blood glucose remains or becomes inadequate (HbA1c ≥ 6.5%, or other higher level agreed with the individual) if:
• the person is at significant risk of hypoglycaemia or its consequences,or • the person does not tolerate a sulfonylurea or a sulfonylurea is contraindicated.
22.214.171.124 Only continue DPP-4 inhibitor therapy if the person has had a beneficial metabolic response (a reduction of at least 0.5 percentage points in HbA1c in 6 months). Points for consideration
• NICE TA288 recommends the use of dapagliflozin. This application is in line with TA288.
• NICE state: “When NICE recommends a treatment 'as an option', the NHS must make sure it is available within
[3 months of publicaton]. This means that, if a patient has type 2 diabetes and the doctor responsible for their care thinks that dapagliflozin is the right treatment, it should be available for use, in line with NICE's recommendations.”
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