Losartan and the United States costs of end-stage renal disease by baseline albuminuria in patients with type 2 diabetes and nephropathy.
BACKGROUND
Type 2 diabetes is the leading cause of end-stage renal disease (ESRD). The Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study provided the opportunity to estimate costs associated with ESRD by baseline albuminuria from a United States perspective.


METHODS
Costs for ESRD in patients with diabetes were estimated by baseline albuminuria using the U.S. Renal Data System by using the number of days each patient experienced ESRD and the daily estimated U.S. cost of ESRD.


RESULTS
The losartan-based antihypertensive therapy group experienced a 28.6% (P=0.002) reduction in the risk of the development of ESRD compared with placebo-based conventional antihypertensive therapy. The previously estimated annual ESRD-related cost saving in the losartan group was 5,144 dollars (95% CI 1,701-8,586 dollars, P=0.003) at 3.5 years. With the cost of losartan, the net savings in the losartan group was estimated at 3,522 dollars (143-6,900 dollars, P=0.041) by 3.5 years. More ESRD-free days were observed and reduced ESRD costs estimated with losartan-based treatment over all levels of baseline albuminuria.


CONCLUSIONS
Treatment with losartan in patients with type 2 diabetes and nephropathy in the RENAAL study not only reduces the incidence of ESRD, but is also estimated from a U.S. perspective to result in substantial cost savings over the 3.5-year duration of the trial across all levels of baseline albuminuria.
Alexander
Charles M
CM
Outcomes Research & Management, Merck Research Laboratories, Merck & Co., Inc., West Point, Pennsylvania 19486, USA. charles_alexander@merck.com
Lyle
Paulette A
PA
Keane
William F
WF
Carides
George W
GW
Zhang
Zhongxin
Z
Shahinfar
Shahnaz
S
D000419:Albuminuria / Q000188:drug therapy / Q000191:economics*; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000191:economics*; D019808:Losartan / Q000191:economics* / Q000627:therapeutic use; D014481:United States
D000959:Antihypertensive Agents; D019808:Losartan