title: Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria.
abstract: OBJECTIVE
  The purpose of this study was to project the cumulative incidence of end-stage renal disease (ESRD), life expectancy, and costs in a Spanish setting of treating patients with diabetes, hypertension, and microalbuminuria with either standard hypertension treatment alone or standard hypertension treatment plus irbesartan 300 mg daily.
  
  
  METHODS
  A peer-reviewed, published Markov model that simulated progression from microalbuminuria to nephropathy, doubling of serum creatinine, ESRD, and all-cause mortality in patients with hypertension, type 2 diabetes, and microalbuminuria was adapted to a Spanish setting. Two strategies were compared: (1) irbesartan versus (2) standard hypertension care with comparable blood pressure control; both began in diabetic hypertensive subjects with microalbuminuria. Cumulative incidence of ESRD, costs, and life expectancy were projected for a hypothetical cohort of 1000 subjects. Future costs and life expectancy were discounted at 3% yearly. A 25-year time horizon and third party payer perspective were used.
  
  
  RESULTS
  When compared to standard blood pressure control, irbesartan was projected to reduce the cumulative incidence of ESRD from (mean +/- standard deviation) 24 +/- 1% to 9 +/- 2%, save 11,082 +/- 2,996 euro, and add 1.40 +/- 0.27 life years per treated patient. The superiority of irbesartan over standard care was robust under a wide range of plausible assumptions.
  
  
  CONCLUSIONS
  Treating patients with hypertension, microalbuminuria, and type 2 diabetes with irbesartan was projected to reduce the incidence of ESRD, extend life, and reduce costs.
authors.affiliation: CORE-Center for Outcomes Research, 4102 Binningen/Basel, Switzerland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Palmer
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Stéphane
authors.initials: S
authors.lastname: Roze
authors.forename: Pablo
authors.initials: P
authors.lastname: Lapuerta
authors.forename: Roland
authors.initials: R
authors.lastname: Chen
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gabriel
authors.forename: Paulo
authors.initials: P
authors.lastname: Carita
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rodby
authors.forename: Dick
authors.initials: D
authors.lastname: de Zeeuw
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Fernando
authors.initials: F
authors.lastname: De Alvaro
mesh_terms: D000419:Albuminuria / Q000191:economics / Q000453:epidemiology* / Q000209:etiology*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D017046:Cost Savings; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D000077405:Irbesartan; D008017:Life Expectancy; D008390:Markov Chains; D013030:Spain / Q000453:epidemiology; D013777:Tetrazoles / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan