title: Cost-effectiveness of screening and early treatment of nephropathy in patients with insulin-dependent diabetes mellitus.
abstract: Studies have demonstrated that "antihypertensive" treatment with angiotensin-converting enzyme inhibitors (ACEI) may retard the progress of nephropathy in patients with insulin-dependent diabetes mellitus. To obtain an indication of the potential effect of ACEI treatment and as a guide to future research, the effects of screening and early ACEI treatment programs were estimated using cost-effectiveness models. The preliminary analysis suggests that the early treatment of insulin-dependent diabetes mellitus patients with ACEI is likely to be a very cost-effective use of health care resources. The cost-effectiveness ratio for screening and treatment at the stage of microalbuminuria ($7,900 to $16,500 per year of life saved) compares favorably with those of other medical life-saving interventions. Less-aggressive programs (screening followed by treatment at the stage of proteinuria) would improve life expectancy to a lesser extent but could save net health care costs as well as years of life. Although more exact and comprehensive cost-effectiveness analysis must await clinical trials, these illustrative results demonstrate the range of cost-effectiveness that can be expected from these programs and identify data needed for more decisive policy conclusions.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
authors.forename: J E
authors.initials: JE
authors.lastname: Siegel
authors.forename: A S
authors.initials: AS
authors.lastname: Krolewski
authors.forename: J H
authors.initials: JH
authors.lastname: Warram
authors.forename: M C
authors.initials: MC
authors.lastname: Weinstein
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008403:Mass Screening / Q000191:economics; D008954:Models, Biological
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors