title: Modelling and costing the consequences of using an ACE inhibitor to slow the progression of renal failure in type I diabetic patients.
abstract: Antihypertensive drugs slow the progressive decline in renal function seen in patients with insulin-dependent diabetes and nephropathy. In a recent study, the ACE inhibitor captopril protected against this deterioration in renal function. We developed an economic model to analyse the cost impact of ACE inhibitor treatment on progression to endstage renal failure (ESRF) in diabetic patients over 4 years. Two scenarios were compared: one describing the progression of a cohort of 1000 patients receiving 25 mg captopril three times daily, and the other for an equivalent cohort without such prophylactic treatment. Previously published data were used to estimate the transition rates for each stage from the onset of renal failure until death. All direct costs were discounted by an annual rate of 6%, and were subjected to sensitivity analysis. The discounted cost saving of ACE inhibitor treatment for a cohort of 1000 patients was estimated as 0.95 million pounds over 4 years. Under sensitivity analysis, these results were very robust to variations in the costs of ESRF treatment. Prophylactic treatment with ACE inhibitors was predicted to provide substantial increases in life expectancy and reduction in the incidence of ESRF, while also providing significant economic savings.
authors.affiliation: Department of Medicine, King's College School of Medicine and Dentistry, London, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Hendry
authors.forename: G C
authors.initials: GC
authors.lastname: Viberti
authors.forename: S
authors.initials: S
authors.lastname: Hummel
authors.forename: A
authors.initials: A
authors.lastname: Bagust
authors.forename: J
authors.initials: J
authors.lastname: Piercy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D002216:Captopril / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000191:economics*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D018450:Disease Progression; D004739:England; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D017059:Models, Econometric; D012680:Sensitivity and Specificity
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril