Pharmacoeconomic aspects of losartan treatment to delay progression of renal disease in patients with Type 2 diabetes.
There is growing evidence from clinical trials that losartan (Cozaar, Merck & Co., Inc.) and other angiotensin (A)-II-receptor antagonists have beneficial effects on the progression of renal disease among Type 2 diabetic patients beyond the benefits derived from the effect of blood-pressure lowering alone [corrected]. Comparators used is the studies were not angiotensin-converting enzyme-inhibitors but typically conventional hypertensive therapy plus placebo, placebo alone and in one case, amlodipine. These trials have reported reductions in progression to end stage renal disease (ESRD) (losartan and irbesartan) and to nephropathy (irbesartan). An important pharmacoeconomic question is whether potential cost-savings on reduced progression to ESRD and nephropathy outweigh the extra costs of A-II-antagonist treatment. This paper will review the published economic studies for A-II-receptor antagonists and their pharmacoeconomic implications. In particular, potential pharmacoeconomic implications and related methodological aspects of the recent RENAAL trial for losartan are considered.
Postma
Maarten J
MJ
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Department of Social Pharmacy, Pharmaco-epidemiology & Pharmacotherapy, The Netherlands. m.postma@farm.rug.nl
Kruidhof
Hanneke
H
de Jong-van den Berg
Lolkje T W
LT
de Zeeuw
Dick
D
D000804:Angiotensin II / Q000502:physiology*; D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D000077405:Irbesartan; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D019808:Losartan / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D057911:Angiotensin Receptor Antagonists; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000804:Angiotensin II; D000077405:Irbesartan; D019808:Losartan