The cost-effectiveness of irbesartan in the treatment of hypertensive patients with type 2 diabetic nephropathy.
BACKGROUND
End-stage renal disease (ESRD)-related health care costs are substantial. Improving clinical outcomes in patients at risk of progression to ESRD could lead to considerable health care savings.


OBJECTIVE
We estimated the cost-effectiveness of irbesartan compared with placebo or amlodipine in the treatment of patients with type 2 diabetes mellitus, hypertension, and overt nephropathy.


METHODS
Three treatments for hypertension patients with type 2 diabetes mellitus and nephropathy were assessed: (1) irbesartan, (2) amlodipine, and (3) placebo. A Markov model was developed based on primary data from the Irbesartan in Diabetic Nephropathy Trial and the United States Renal Data System. Projected survival and costs were compared for each treatment at 3-, 10-, and 25-year time horizons. Different assumptions of treatment benefits and costs were tested with use of sensitivity analyses.


RESULTS
At 10 and 25 years, the model projected irbesartan to be both the least costly and most effective (ie, demonstrating a survival advantage) strategy. At 25
Rodby
Roger A
RA
Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA. rrodby@mindsring.com
Chiou
Chion Fang
CF
Borenstein
Jeff
J
Smitten
Allison
A
Sengupta
Nishan
N
Palmer
Andrew J
AJ
Roze
Stéphane
S
Annemans
Lieven
L
Simon
Teresa A
TA
Chen
Roland S
RS
Lewis
Edmund J
EJ
D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D000077405:Irbesartan; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D013777:Tetrazoles / Q000191:economics* / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D017311:Amlodipine; D000077405:Irbesartan