Letter to the Editor: Indication-Specific Cost-Effectiveness of Empagliflozin Versus Dapagliflozin: Implications for Clinical and Policy Decision-Making

Effectiveness of Empagliflozin and Dapagliflozin in ChinesePatients with Type 2 Diabetes Mellitus", which provides valuable real-world, head-to-head evidence comparing two widely used sodium-glucose cotransporter-2 (SGLT2) inhibitors.Using propensity score-matched retrospective data, the authors demonstrate largely comparable effects of empagliflozin and dapagliflozin on glycolipid metabolism, liver and kidney function in patients with type 2 diabetes mellitus (T2DM), with few clinically meaningful differences observed.1 Direct comparative effectiveness studies are highly important, particularly in the real-world setting.As the indications for SGLT2 inhibitors have expanded beyond T2DM to include heart failure (HF) and chronic kidney disease (CKD), and as long-term treatment is increasingly required, understanding not only comparisons in clinical effectiveness, but also relative economic value, has become essential for healthcare decision-making.Motivated by the findings of Zheng et al., I conducted a systematic literature review to evaluate and compare the cost-effectiveness and cost-utility evidence for empagliflozin versus dapagliflozin across their three main prescribing indications: T2DM, HF, and CKD.The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.PubMed/MEDLINE was searched in December 2025 to identify studies published from 1 January 2020 onwards reporting cost-effectiveness analyses (CEAs) or cost-utility analyses (CUAs) comparing empagliflozin and dapagliflozin.Two search strategies were applied: (1) empagliflozin AND dapagliflozin AND cost*; and (2) empagliflozin AND dapagliflozin AND econom*.Thirteen studies met inclusion criteria: four in T2DM, 2-5 seven in HF, [6][7][8][9][10][11][12] and two in diabetic kidney disease (DKD).13,14 Substantial heterogeneity was observed across studies in terms of analytical perspective, model structure (predominantly Markov model), and time horizon (predominantly lifetime).