[Health economic consequences of the use of irbesartan in patients in Germany with type 2 diabetes, nephropathy and hypertension].
OBJECTIVE
The "Irbesartan in Diabetic Nephropathy Trial" (IDNT), demonstrated a reduction in the combined endpoint of doubling of serum creatinine, end-stage renal disease (ESRD) or death compared to control or amlodipine arms in patients with hypertension, type 2 diabetes and overt nephropathy when treated with irbesartan. Aim of this study is to compare long-term consequences in costs and outcomes of IDNT treatment alternatives from the German health care system's perspective.


METHODS
A Markov model simulated progression from overt nephropathy to doubling of serum creatinine, end-stage renal disease, and death in patients with hypertension, type 2 diabetes and overt nephropathy for the three treatment arms. Treatment-specific probabilities were derived from IDNT. German-specific ESRD-related data were retrieved from published sources to reflect local management practices, ESRD outcomes and costs. A time horizon of 10 years was used. Delay in onset of ESRD and mean costs per patient were calculated. Future costs were discounted at 5 % per annum.


RESULTS
The cumulative incidence of ESRD after 10 years with irbesartan (36 %) is lower compared to amlodipine (49 %) or control (45 %). Irbesartan leads to cost savings of 14 424 EUR and 8 720 EUR per patient versus amlodipine or control respectively.


CONCLUSIONS
Treating patients with hypertension, type 2 diabetes and nephropathy using irbesartan lowers the cumulative incidence of ESRD and is cost-saving compared to amlodipine or control.
Palmer
A J
AJ
Center for Outcomes Research, Basel, Schweiz. AP@thecenter.ch
Annemans
L
L
Roze
S
S
Lamotte
M
M
Rodby
R A
RA
Ritz
E
E
D017311:Amlodipine / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000191:economics / Q000627:therapeutic use*; D003198:Computer Simulation; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D000077405:Irbesartan; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D016030:Kidney Transplantation / Q000191:economics; D008297:Male; D008390:Markov Chains; D006435:Renal Dialysis / Q000191:economics; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D017311:Amlodipine; D003404:Creatinine; D000077405:Irbesartan