An economic evaluation of Losartan therapy in type 2 diabetic patients with nephropathy: an analysis of the RENAAL study adapted to France.
BACKGROUND
The RENAAL study enrolled 1,513 patients with type 2 diabetes mellitus and nephropathy defined by the presence of proteinuria (urinary albumin: creatinine ratio 300 mg/g or proteinuria > 500 mg per day). Compared to placebo, losartan therapy reduced by 16% (p=0.02) the risk of a composite endpoint (doubling of baseline serum creatinine level, end stage renal disease, or death) and by 28% (p=0.002) the risk of progression to end stage renal disease (ESRD).


METHODS
The objective of this study was to compare, using French economic data, the additional cost of losartan therapy with the savings in cost generated by a decrease in the number of end stage renal disease days. Prospectively collected health care resource utilization were used (N(losartan)=751, N(placebo)=762). The follow-up period was 4 years.


RESULTS
The mean cumulative cost of losartan over 4 years was 1,603 euros per patient. The reduction in the number of ESRD days over 4 years in patients treated with losartan significantly decreased costs associated with ESRD by 7,438 euros per patient (CI 95%: 3,029 euros - 11,847 euros, p=0.001). Compared to the placebo group, the average cost per patient over 4 years in the losartan group was lower by 5,834 euros (CI 95%: 1,407 euros - 10,301 euros, p=0.01).


CONCLUSIONS
In addition to the medical benefit, this analysis demonstrated the economic relevance of treatment with losartan in type 2 diabetic patients with nephropathy.
Souchet
T
T
Merck Sharp & Dohme - Chibret, Paris, France. thierry_souchet@merck.com
Durand Zaleski
I
I
Hannedouche
T
T
Rodier
M
M
Gaugris
S
S
Passa
P
P
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D019808:Losartan / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011507:Proteinuria; D044469:Racial Groups; D012307:Risk Factors; D012907:Smoking; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D003404:Creatinine; D019808:Losartan