Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria.
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.
Palmer
Andrew J
AJ
CORE-Center for Outcomes Research, 4102 Binningen/Basel, Switzerland.
Annemans
Lieven
L
Roze
Stéphane
S
Lapuerta
Pablo
P
Chen
Roland
R
Gabriel
Sylvie
S
Carita
Paulo
P
Rodby
Roger A
RA
de Zeeuw
Dick
D
Parving
Hans-Henrik
HH
De Alvaro
Fernando
F
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*
D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan