What is the least expensive DPP-4 (Dipeptidyl Peptidase-4) inhibitor for diabetes care and its monthly cost?

Alogliptin is the Least Expensive DPP-4 Inhibitor for Diabetes Care

Alogliptin is the least expensive DPP-4 inhibitor with a monthly cost of $170 (NADAC) for the maximum daily dose of 25 mg. 1

Cost Comparison of DPP-4 Inhibitors

According to the American Diabetes Association's Standards of Medical Care in Diabetes, the costs of DPP-4 inhibitors at maximum approved daily doses are:

• Alogliptin (25 mg): $234 AWP/$170 NADAC per month 1
• Saxagliptin (5 mg): $490 AWP/$392 NADAC per month 1
• Linagliptin (5 mg): $494 AWP/$395 NADAC per month 1
• Sitagliptin (100 mg): $516 AWP/$413 NADAC per month 1

In more recent data (2024), the costs have increased but the relative positioning remains similar:

• Alogliptin (25 mg): $234 AWP/$161 NADAC per month 1
• Saxagliptin (5 mg): $524 AWP/$466 NADAC per month 1
• Linagliptin (5 mg): $630 AWP/$504 NADAC per month 1
• Sitagliptin (100 mg): $657 AWP/$525 NADAC per month 1

Efficacy Considerations

• All DPP-4 inhibitors have similar efficacy in reducing HbA1c by approximately 0.6-1.1% in studies up to 52 weeks 2
• They work by preventing the inactivation of glucagon-like peptide-1 (GLP-1), which increases insulin secretion and reduces glucagon secretion 3
• When considering cost-effectiveness, a Brazilian study found sitagliptin in combination with metformin to be the most cost-effective DPP-4 inhibitor, with the greatest reduction in HbA1c per dollar spent 4

Clinical Application Algorithm

1. First-line therapy: Start with metformin as the initial medication for type 2 diabetes due to its low cost ($2-4 per month) and established cardiovascular benefits 1
2. Second-line therapy: If additional medication is needed, consider adding alogliptin as the most affordable DPP-4 inhibitor option 1
3. Special populations: For patients with renal impairment, dose adjustment may be required for alogliptin, while linagliptin may be preferred as it doesn't require dose adjustment in renal impairment (though at a higher cost) 1

Important Considerations

• DPP-4 inhibitors are generally well-tolerated with minimal risk of hypoglycemia when used as monotherapy 5, 2
• They are weight-neutral, which is an advantage over some other diabetes medications 2
• The monthly cost difference between the least expensive (alogliptin) and most expensive (sitagliptin) DPP-4 inhibitor is approximately $243 per month based on 2019 data, which translates to over $2,900 per year in potential savings 1

Common Pitfalls to Avoid

• Don't automatically prescribe the newest or most marketed DPP-4 inhibitor without considering cost implications 1
• Be aware that insurance formularies may influence which DPP-4 inhibitor is actually least expensive for a specific patient, despite the general market pricing 1
• While alogliptin is the least expensive, remember that combination therapy with metformin is often more effective and should be considered when appropriate 4, 2