title: Markov modeling analysis of health and economic outcomes of therapy with valsartan versus amlodipine in patients with type 2 diabetes and microalbuminuria.
abstract: OBJECTIVE
  To estimate 8-year health and economic outcomes of the angiotensin II receptor blocker valsartan versus the calcium channel blocker amlodipine in therapy of patients with type 2 diabetes and microalbuminuria based on clinical endpoints from a 6-month randomized controlled clinical trial, the MicroAlbuminuria Reduction With VALsartan (MARVAL) study.
  
  
  METHODS
  We developed a Markov model that utilized urinary albumin excretion rate data to project patient distributions to 7 possible health states over 8 years. For each health state, we identified quality-adjustment weights (health utilities) and medical care costs from public sources. The model then calculated mean quality-adjusted survival, medical care costs, and cost-effectiveness ratios for each treatment arm. Treatment arms were compared with the incremental cost-effectiveness ratio.
  
  
  RESULTS
  Patients treated with valsartan gained 7 months (mean) per patient of quality-adjusted survival relative to patients treated with amlodipine (77 versus 70 months; P<0.01); valsartan patients also incurred 32,412 dollars (mean) per patient lower medical costs than amlodipine patients (92,058 dollars versus 124,470 dollars; P<0.01). Model results were consistent for each year of analysis and robust to changes in key model parameters.
  
  
  CONCLUSIONS
  This research (1) extends 6-month clinical trial outcomes to an 8-year period, (2) translates health outcomes from technical clinical endpoints to quality-adjusted survival, and (3) estimates economic consequences of therapeutic outcomes. The results quantify the favorable long-term health (i.e., quality-adjusted survival) and economic benefits (i.e., lower total medical costs) of therapy with valsartan, an angiotensin II receptor blocker, versus amlodipine, a calcium channel blocker, in the treatment of patients with type 2 diabetes and microalbuminuria based on an extension of the results of a short-term clinical (MARVAL) trial. These research findings are important to the extent patients with type 2 diabetes and microalbuminuria do not receive the recommended antihypertensive agents that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers).
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109, USA. deans@umich.edu
authors.forename: Dean G
authors.initials: DG
authors.lastname: Smith
authors.forename: Anh B
authors.initials: AB
authors.lastname: Nguyen
authors.forename: Corey N
authors.initials: CN
authors.lastname: Peak
authors.forename: Feride H
authors.initials: FH
authors.lastname: Frech
mesh_terms: D000419:Albuminuria / Q000188:drug therapy*; D017311:Amlodipine / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D006302:Health Services Research; D006801:Humans; D008390:Markov Chains; D010043:Outcome and Process Assessment, Health Care; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States; D014633:Valine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use*; D000068756:Valsartan
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine