within the preferential medication supply according to the List of Vital and Essential Drugs. Patients and Methods: the analytical model of decision-making was created using the MS Excel software to analyze the budgetary impact and "missed opportunities" when using alogliptin compared to other DPP-4 inhibitors for T2D. This model included only direct medical costs for one patient (medical costs of medical treatment with DPP-4 inhibitors). The target population included adults with T2D who received DPP-4 inhibitors from the List of Vital and Essential Drugs to enhance ineffective therapy with metformin based on the monitoring of the IQVIA drug purchase in 2021. Results: complete switch to alogliptin in the target population (249,700 patients with T2D) eased the strain on a budget of the health care system by 18%, or 839.7 million of RUB, over a 1-year therapy. Considering the previously calculated penetration rate, the average budget savings of the health care system over a 5-year therapy will be 11% or 448.6 of RUB. In addition, the analysis of "missed opportunities" has demonstrated that prescribing alogliptin in adults with T2D (considering replacement schedule) allows for additional treatment of 13,693 patients within the first year and 146,311 patients within five years in a fixed budget. Conclusion: in T2D, alogliptin is more effective compared to other DPP-4 inhibitors in terms of economics due to lower cost and similar efficacy. KEYWORDS: diabetes, dipeptidyl peptidase 4 inhibitors, alogliptin, analysis of budgetary impact, pharmacoeconomics. FOR CITATION: Nedogoda S.V., Salasyuk A.S., Barykina I.N. et al. Analysis of the budgetary impact of alogliptin in type 2 diabetes and unachieved target glycemia with metformin. Russian Medical Inquiry. 2021;5(9):559–567 (in Russ.). DOI: 10.32364/2587-6821-2021-5-9-559-567.