Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been recommended in diabetes guidelines and shown to be cost effective. However, existing model-based cost-effectiveness analyses of SGLT2i have limitations regarding their representativeness, the integration of all treatment effects and the lack of real-world evidence.

Dutch reimbursement criteria of SGLT2i represent 16% of individuals with diabetes. Their characteristics significantly differ from SGLT2i trial populations. for individuals who qualified for reimbursement, SGLT2i were cost effective at €5440/QALY compared with care-as-usual. Several pragmatic scenarios were tested; the cost effectiveness estimation remained favorable. the MICADO model well captured the benefit of SGLT2i, with less than 25% mean absolute percentage error in incidence prediction of complications over the trial’s follow-up period.

The MICADO model was a useful tool to simulate the disease progression of individuals with diabetes, keep track of costs and quality-adjusted life years, and support decision-making. Although the reimbursement criteria will result in a different target group compared with trials, SGLT2i can be considered cost effective in a routine care population.