[Medicamentous kidney protection in type 2 diabetic patients--is cheaper also more economical? A model calculation for Swiss health care].
Impaired renal function occurs in about 50% of patients suffering from type 2 diabetes, and diabetic nephropathy has become the leading cause of endstage renal disease. Reduction of blood pressure to levels around 120/80 mmHg is one of the most effective way to slow progression of diabetic nephropathy. Recent meta-analyses, however, have emphasized on the fact that ACE inhibitors (ACEI) and non-dihydropyridine calcium channel blockers (NDHP-CCB) exert nephro-protective effects which go beyond the effect of blood pressure reduction. This has lately been confirmed by a prospective trial in comparison to the betablocker atenolol. Based on these data, demographics of the Swiss population, literature data on mortality rates of type 2 diabetics with impaired renal function and studies on true costs of antihypertensives, we calculated the costs of a longterm intervention (20 years) with antihypertensives in 3536 middle-aged Swiss patients with type 2 diabetes and macro-albuminuria whose antihypertensive regimen was based either on the ACEI lisinopril, or the ND-HP-CCB verapamil, or the betablocker atenolol. Under atenolol, acquisition costs were lowest, whereas faster loss of renal function over time increased mortality rate and thus reduced the number of patients to be treated. Nevertheless, due to the fact that patients reached uremia and had to be dialyzed, 20 years of atenolol-based regimen with costs of 316 millions of Swiss francs turned out to be much more expensive than the lisinopril- or the verapamil-based regimen with 121 and 38 millions of Swiss francs, respectively. Thus, low acquisition cost is not necessarily the only important determinant of overall costs of drug therapy.
Faller
J
J
Departement Innere Medizin, Inselspital Bern.
Hess
B
B
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001262:Atenolol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000191:economics; D007677:Kidney Function Tests; D017706:Lisinopril / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D013557:Switzerland; D014700:Verapamil / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001262:Atenolol; D014700:Verapamil; D017706:Lisinopril
Medikamentöse Nephroprotektion bei Typ 2-Diabetikern--ist billiger auch ökonomischer? Eine Modellrechnung für Schweizer Verhältnisse.