title: Losartan reduces the costs associated with diabetic end-stage renal disease: the RENAAL study economic evaluation.
abstract: OBJECTIVE
  To evaluate the within-trial effect of losartan and conventional antihypertensive therapy (CT) compared with placebo and CT on the economic cost associated with end-stage renal disease (ESRD).
  
  
  METHODS
  The Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan (RENAAL) study was a multinational double-blind randomized placebo-controlled clinical trial designed to evaluate the renal protective effects of losartan on a background of CT (excluding ACE inhibitors and angiotensin II receptor agonists [AIIAs]) in patients with type 2 diabetes and nephropathy. The primary composite end point was doubling of serum creatinine, ESRD, or death. Data on the duration of ESRD were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the days each patient experienced ESRD with the cost of ESRD over time. The cost of ESRD for individuals with diabetes was estimated using data from the U.S. Renal Data System. Total cost was estimated as the sum of the cost associated with ESRD and the cost of study therapy. RESULTS-We estimated that losartan and CT compared with placebo and CT reduced the number of days with ESRD by 33.6 per patient over 3.5 years (P = 0.004, 95% CI 10.9-56.3). This reduction in ESRD days resulted in a decrease in cost associated with ESRD of 5144 US dollars per patient (P = 0.003, 95% CI 1701 to 8587 US dollars). After accounting for the cost of losartan, the reduction in ESRD days resulted in a net savings of 3522 US dollars per patient over 3.5 years (P = 0.041, 143 to 6900 US dollars).
  
  
  CONCLUSIONS
  Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the incidence of ESRD, but also resulted in substantial cost savings.
authors.affiliation: Departments of Internal Medicine and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0354, USA. wherman@umich.edu
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Shahinfar
authors.forename: George W
authors.initials: GW
authors.lastname: Carides
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Dasbach
authors.forename: William C
authors.initials: WC
authors.lastname: Gerth
authors.forename: Charles M
authors.initials: CM
authors.lastname: Alexander
authors.forename: John R
authors.initials: JR
authors.lastname: Cook
authors.forename: William F
authors.initials: WF
authors.lastname: Keane
authors.forename: Barry M
authors.initials: BM
authors.lastname: Brenner
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics; D017046:Cost Savings; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000191:economics; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000191:economics; D019808:Losartan / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan