title: Routine treatment of insulin-dependent diabetic patients with ACE inhibitors to prevent renal failure: an economic evaluation.
abstract: The objective of this study was to determine how effective angiotensin-converting enzymes (ACEs) must be in preventing diabetic nephropathy to warrant routine administration to insulin-dependent diabetic patients. A Markov model was used to compare three strategies designed to prevent the development of end-stage renal disease in insulin-dependent diabetic patients. Strategy I, screening for microalbuminuria and treatment of incipient nephropathy as currently recommended, was compared with strategy II, a protocol in which patients were routinely administered an ACE inhibitor 5 years after diagnosis of diabetes, and strategy III, in which patients at high risk for nephropathy were routinely treated and low-risk patients followed a protocol in which patients were treated with an ACE inhibitor if they developed hypertension and/or macroproteinuria. The model predicted that strategy II would produce as many quality-adjusted life-years as strategy I at nearly the same cost if routine drug therapy reduced the rate of development of microalbuminuria by 26% in all patients. Strategy III produced as many quality-adjusted life-years at less cost than strategy I if a high-risk cohort could be identified with a rate of developing microalbuminuria at four times the rate of low-risk patients and if drug therapy reduced the rate of developing microalbuminuria in this high-risk group by 20%. In conclusion, routine ACE inhibitor therapy could prove to be cost-effective, especially if high-risk individuals could be identified. A prospective trial examining this goal should be considered.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. bkiberd@is.dal.ca
authors.forename: B A
authors.initials: BA
authors.lastname: Kiberd
authors.forename: K K
authors.initials: KK
authors.lastname: Jindal
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D008390:Markov Chains; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D018401:Sample Size
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors