A French cost-consequence analysis of the renoprotective benefits of irbesartan in patients with type 2 diabetes and hypertension.
OBJECTIVE
We performed a cost-consequence analysis in a French setting of the renoprotective benefit of irbesartan in hypertensive type 2 diabetes patients over a 25-year period.


METHODS
A previously published Markov model simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease and death. Three treatment strategies with analogous blood pressure control were compared: (A) control--conventionally medicated antihypertensive therapy (excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers) initiated at microalbuminuria; (B) early irbesartan--(300 mg daily added to control, initiated with microalbuminuria) and (C) late irbesartan--(300 mg daily, initiated with overt nephropathy). Probabilities came from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial and other sources. Clinical and economic outcomes were projected over 25 years. Annual discount rates were 3%.


RESULTS
Compared to control, early use of irbesartan added (mean +/- standard deviation) 1.51 +/- 0.08 undiscounted life years (discounted: 0.94 +/- 0.05 years), while late irbesartan added 0.07 +/- 0.01 (0.04 +/- 0.01) years/patient. Early irbesartan added 1.03 +/- 0.06 discounted quality-adjusted life years (QALYs), while late irbesartan added 0.06 +/- 0.01 QALYs. Early and late irbesartan treatments were projected to save 22,314 +/- 1273 euro and 6619 +/- 820 euro/patient, respectively versus control. Sensitivity analysis showed that even over short time horizons both irbesartan treatments were superior to the control group.


CONCLUSIONS
In France, early irbesartan treatment improved quality and length of life and reduced costs in hypertensive patients with type 2 diabetes and microalbuminuria. Late irbesartan therapy is beneficial, but earlier irbesartan leads to better outcomes.
Palmer
Andrew J
AJ
CORE--Center for Outcomes Research, Allschwil/Basel, Switzerland. info@thecenter.ch
Valentine
William J
WJ
Tucker
Daniel M D
DM
Ray
Joshua A
JA
Roze
Stéphane
S
Annemans
Lieven
L
Lapuerta
Pablo
P
Chen
Roland
R
Gabriel
Sylvie
S
Carita
Paulo
P
Rodby
Roger A
RA
de Zeeuw
Dick
D
Parving
Hans-Henrik
HH
Laville
Maurice
M
D000419:Albuminuria / Q000150:complications / Q000188:drug therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D018450:Disease Progression; D004334:Drug Administration Schedule; D005602:France; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D000077405:Irbesartan; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D013777:Tetrazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan