The impact of losartan on the lifetime incidence of ESRD and costs in Mexico.
BACKGROUND
The RENAAL (Reduction of Endpoints in Type 2 Diabetes with the Angiotensin II Antagonist Losartan) study demonstrated that treatment with losartan reduced the risk of ESRD by 29% among hypertensive patients with type 2 diabetes and diabetic nephropathy. The objective of this study was to project the effect of losartan compared to placebo on the lifetime incidence of ESRD and associated costs from a third-party payer perspective in Mexico.


METHODS
A competing risks method was used to estimate lifetime incidence of ESRD, while accounting for the risk of death without ESRD. The cost associated with ESRD was estimated by combining the cumulative incidence of ESRD with the lifetime cost associated with ESRD. Total cost was estimated as the sum of the cost associated with ESRD from the three main public institutions in Mexico, the lifetime cost of losartan therapy, and other costs (non-ESRD/non-losartan) expected for patients with type 2 diabetes. Survival was estimated by weighting the life expectancies with and without ESRD by the cumulative risk of ESRD.


RESULTS
The projected lifetime incidence of ESRD for losartan patients was lower (66%) compared with placebo patients (83%). This reduction in ESRD resulted in a decrease in ESRD-related cost of M dollar 49,737 per patient and a discounted gain of 0.697 life years per patient. After accounting for the cost of losartan and the additional cost associated with greater survival, we projected that treatment with losartan would result in a net savings of M dollar 24,073 per patient.


CONCLUSIONS
Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the within-trial incidence of ESRD but is projected to result in lifetime reductions in ESRD, increased survival, and overall cost savings to public institutions in Mexico.
Arredondo
Armando
A
National Institute of Public Health, Cuernavaca, Mexico. aarredon@insp.mx
Burke
Thomas A
TA
Carides
George W
GW
Lemus
Edith
E
Querol
Julio
J
D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics; D003928:Diabetic Nephropathies / Q000150:complications* / Q000191:economics / Q000453:epidemiology; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008017:Life Expectancy; D019808:Losartan / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000191:economics; D012306:Risk; D016019:Survival Analysis
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D019808:Losartan