Loxenatide demonstrated a clear cost-utility advantage over sitagliptin in Chinese patients with type 2 diabetes at high cardiovascular risk, with an ICER of 82,058.77 CNY per QALY, well below the willingness-to-pay threshold of 299,100 CNY per QALY.
Key Findings
Results
Loxenatide was cost-effective compared to sitagliptin in the base-case analysis, with an ICER well below the willingness-to-pay threshold.
The incremental cost-effectiveness ratio (ICER) for loxenatide versus sitagliptin was 82,058.77 CNY per QALY.
The willingness-to-pay threshold was set at three times China's per capita GDP in 2025, equal to 299,100 CNY per QALY.
The ICER was approximately 27% of the willingness-to-pay threshold, indicating substantial cost-effectiveness headroom.
Both costs and health outcomes were discounted at an annual rate of 5%.
Results
Probabilistic sensitivity analysis confirmed loxenatide was cost-effective in 100% of simulations.
1,000 Monte Carlo simulations were conducted for the probabilistic sensitivity analysis.
Loxenatide consistently generated additional QALYs across all simulations.
Results were described as demonstrating 'robust model results.'
Scenario analysis also confirmed the robustness of the model results.
Results
One-way sensitivity analysis identified the hazard ratio for heart failure and loxenatide cost as the parameters most affecting the ICER.
Despite sensitivity to these parameters, loxenatide remained cost-effective across all scenarios tested.
The one-way sensitivity analysis was used to assess the robustness of the base-case results.
No scenario in the one-way sensitivity analysis caused the ICER to exceed the willingness-to-pay threshold.
Methods
A five-state Markov model was developed to simulate long-term disease progression in type 2 diabetes patients at high cardiovascular risk.
The five health states were: event-free, myocardial infarction, stroke, heart failure, and death.
The model used a 1-year cycle length over a 40-year time horizon.
Transition probabilities were estimated using the UKPDS 82 risk equations.
Clinical efficacy inputs were obtained from the FIGHTING-2 study, which provided the first direct comparison of cardiovascular outcomes between loxenatide and sitagliptin in Chinese T2DM patients at high cardiovascular risk.
Cost and utility parameters were derived from Chinese local literature and the National Reimbursement Drug List.
Methods
The FIGHTING-2 study, presented at the 2026 ECIM, provided core efficacy parameters comparing loxenatide to sitagliptin in Chinese T2DM patients at high cardiovascular risk.
The FIGHTING-2 study was the first direct comparison of cardiovascular outcomes between loxenatide and a DPP-4 inhibitor (sitagliptin) in this patient population.
The comparator regimen was sitagliptin 100 mg once daily added to metformin in patients inadequately controlled on metformin alone.
The intervention was loxenatide 0.2 mg once weekly, a GLP-1 receptor agonist developed in China.
The analysis was conducted from the healthcare system perspective.
Background
Loxenatide is listed for reimbursement in China, but prior to this study, evidence on its long-term cost-effectiveness was limited.
Loxenatide is described as a once-weekly GLP-1 receptor agonist developed in China.
The study population was Chinese patients with type 2 diabetes at high cardiovascular risk who were inadequately controlled with metformin.
The authors state the findings 'provide high-quality evidence to support clinical standardization, rational drug use, reimbursement policy decisions, and optimal allocation of healthcare resources' in China.
What This Means
This research suggests that loxenatide, a once-weekly injectable diabetes medication developed in China, offers good value for money compared to sitagliptin (a daily pill) for Chinese patients with type 2 diabetes who are also at high risk for heart disease. Using a mathematical model that tracked patients over 40 years through various health states—including heart attack, stroke, heart failure, and death—the researchers found that loxenatide cost about 82,059 Chinese yuan per quality-adjusted life year (QALY) gained, which is well below China's cost-effectiveness threshold of approximately 299,100 yuan per QALY. Both medications were used in patients who were not adequately controlled on metformin alone.
The findings were robust across extensive testing. When the researchers varied individual assumptions one at a time, loxenatide remained cost-effective in every scenario, with the biggest influences on the result being the drug's effect on heart failure risk and the cost of loxenatide itself. When they ran 1,000 random simulations varying multiple assumptions simultaneously, loxenatide was cost-effective in all 1,000 cases and consistently produced more quality-adjusted life years than sitagliptin. The clinical data feeding into the model came from the FIGHTING-2 trial, described as the first head-to-head comparison of cardiovascular outcomes between these two drug classes in Chinese patients.
This research matters because type 2 diabetes combined with high cardiovascular risk places a heavy burden on patients and the Chinese healthcare system. The study provides economic evidence to support decisions about which medications should be prioritized and reimbursed. The authors suggest these findings can help guide clinical guidelines, rational prescribing, and healthcare resource allocation for this large patient population in China.
Lai L, Chuan F, Huang Q, Xiong N, Peng C, Zhao R, et al.. (2026). Cost-utility analysis of loxenatide versus DPP-4 inhibitors in Chinese patients with type 2 diabetes at high cardiovascular risk.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1929706