Ramipril prolongs life and is cost effective in chronic proteinuric nephropathies.
BACKGROUND
Our objectives were to predict the long-term cost and efficacy of the angiotensin-converting enzyme, ramipril, in patients with nondiabetic chronic nephropathies.


METHODS
The time to end-stage renal disease (ESRD) was predicted by two different models based on the rate of glomerular filtration rate decline (DeltaGFR) and incidence of ESRD (events) measured during the Ramipril Efficacy in Nephropathy Trial in 117 and 166 patients, respectively, randomized to comparable blood pressure control with ramipril or conventional therapy. Direct medical costs of conservative and renal replacement therapy were estimated by a payer perspective, and cases more and less favorable to ramipril were computed by a sensitivity analysis. The study took place at the Clinical Research Center for Rare Diseases, "Aldo & Cele Daccò," Bergamo, Italy. Patients included those with chronic, nondiabetic nephropathies and persistent urinary protein excretion rate >/=3 g/24 h. Time to ESRD, survival, and direct costs of conservative and renal replacement therapy are discussed.


RESULTS
Both in the DeltaGFR-based or events-based models, ramipril delayed progression to ESRD and prolonged patient survival by 1.5 to 2.2 and 1.2 to 1.4 years, respectively, and saved $16,605 to $23,894 lifetime and $2, 422 to $4203 yearly direct costs per patient. Even in the less favorable hypotheses, ramipril allowed lifetime and yearly cost savings that exceeded 10 to 11 and 20 to 40 times, respectively, the additional costs related to prolonged survival.


CONCLUSIONS
In our study population, ramipril prolongs life while saving money because of its beneficial effect on the course of nondiabetic chronic nephropathies.
Ruggenenti
P
P
Clinical Research Center for Rare Diseases "Aldo e Cele Daccò" and Center for Health Economics (CESAV), Mario Negri Institute for Pharmacological Research, and Unit of Nephrology, Ospedali Riuniti, Azienda Ospedaliera, Bergamo, Italy.
Pagano
E
E
Tammuzzo
L
L
Benini
R
R
Garattini
L
L
Remuzzi
G
G
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000652:urine*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000652:urine; D017257:Ramipril / Q000191:economics* / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril