title: Losartan reduces the costs of diabetic end-stage renal disease: an Asian perspective.
abstract: OBJECTIVE
  To evaluate losartan and conventional antihypertensive therapy (CT) compared with CT alone on the cost associated with end-stage renal disease (ESRD) in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan.
  
  
  METHODS
  Reduction of end-points in non-insulin-dependent diabetes mellitus with the angiotensin II antagonist losartan (RENAAL) was a multinational, double-blind, randomized, placebo-controlled trial to evaluate the renal protective effects of losartan on a background of CT in patients with type 2 diabetes and nephropathy. The primary composite end-point was a doubling of serum creatinine, ESRD or death. Data on the duration of ESRD for the Asian subgroup of patients enrolled in RENAAL were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the number of days each patient experienced ESRD with the average daily cost of dialysis from the third-party payer perspective in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan. Total cost, converted to US dollars, was the sum of ESRD and losartan costs.
  
  
  RESULTS
  Losartan plus CT reduced the number of days with ESRD by 37.9 per patient over 3.5 years compared with CT alone. This reduction in ESRD days resulted in a decrease in the cost associated with ESRD, which ranges from $910 to $4346 per patient over 3.5 years across the six countries or regions. After accounting for the cost of losartan, the reduction in ESRD days resulted in net savings in each of the six countries or regions, ranging from $55 to $515 per patient.
  
  
  CONCLUSIONS
  Treatment with losartan in patients with type 2 diabetic nephropathy not only reduced the incidence of ESRD among Asian patients, but resulted in direct medical cost savings in countries or regions representing Asia.
authors.affiliation: Department of Nephrology, Singapore General Hospital, Singapore.
authors.forename: Wong Kok
authors.initials: WK
authors.lastname: Seng
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Dong Cheol
authors.initials: DC
authors.lastname: Han
authors.forename: Chua Chin
authors.initials: CC
authors.lastname: Teong
authors.forename: Juliana
authors.initials: J
authors.lastname: Chan
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Burke
authors.forename: George W
authors.initials: GW
authors.lastname: Carides
authors.forename: Yon Jong
authors.initials: YJ
authors.lastname: Choi
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics* / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D044466:Asian People; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy / Q000191:economics; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D007723:Korea; D019808:Losartan / Q000191:economics* / Q000627:therapeutic use*; D008296:Malaysia; D012846:Singapore; D013624:Taiwan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D019808:Losartan