An Asian regional analysis of cost-effectiveness of early irbesartan treatment versus conventional antihypertensive, late amlodipine, and late irbesartan treatments in patients with type 2 diabetes, hypertension, and nephropathy.
OBJECTIVE
The prevalence of type 2 diabetes, often leading to diabetic nephropathy, has increased globally, especially in Asia. Irbesartan treatment delays the progression of kidney disease at the early (microalbuminuria) and late (proteinuria) stages of nephropathy in hypertensive type 2 diabetics. This treatment has proven to be cost-effective in Western countries. This study assessed the cost-effectiveness of early irbesartan treatment in Asian settings.


METHODS
An existing lifetime model was reprogrammed in Microsoft Excel to compare irbesartan started at an early stage to irbesartan or amlodipine started at a late stage, and standard treatments from a health-care perspective in China, Malaysia, Thailand, South Korea, and Taiwan. The main effectiveness parameters were incidences of end-stage renal disease, time in dialysis, and life expectancy. All costs were converted to 2004 US$ using official purchasing power parity. Local data were obtained for costs, transplantation,dialysis, and mortality rates. Probabilities regarding disease progression after treatment with the investigated drugs were extracted from two published clinical trials. A probabilistic sensitivity analysis was performed.


RESULTS
Early use of irbesartan yielded the largest clinical and economic benefits reducing need for dialysis by 61% to 63% versus the standard treatment, total costs by 9% (Thailand) to 42% (Taiwan), and increasing life expectancy by 0.31 to 0.48 years. Early irbesartan had a 66% (Thailand) to 95% (Taiwan) probability of being dominant over late irbesartan.


CONCLUSIONS
Although the absolute results varied in different settings, reflecting differences in epidemiology, management, and costs, early irbesartan treatment was a cost-effective alternative in the Asian settings.
Annemans
Lieven
L
Ghent University and IMS Health, Bruxelles, Belgium, and IMS Health, Bruxelles, Belgium.
Demarteau
Nadia
N
Hu
Shanlian
S
Lee
Tae-Jin
TJ
Morad
Zaher
Z
Supaporn
Thanom
T
Yang
Wu-Chang
WC
Palmer
Andrew J
AJ
D017311:Amlodipine / Q000008:administration & dosage / Q000191:economics*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics*; D001208:Asia; D001713:Biphenyl Compounds / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics; D004334:Drug Administration Schedule; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics; D000077405:Irbesartan; D017059:Models, Econometric; D013777:Tetrazoles / Q000008:administration & dosage / Q000191:economics*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D013777:Tetrazoles; D017311:Amlodipine; D000077405:Irbesartan