title: Cost-effectiveness of aliskiren in type 2 diabetes, hypertension, and albuminuria.
abstract: The Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) trial demonstrated that adding aliskiren, an oral direct renin inhibitor, at a dosage of 300 mg/d to the highest approved dosage of losartan and optimal antihypertensive therapy reduces albuminuria over 6 mo among patients with type 2 diabetes, hypertension, and albuminuria. The cost-effectiveness of this therapy, however, is unknown. Here, we used a Markov model to project progression to ESRD, life years, quality-adjusted life years, and lifetime costs for aliskiren plus losartan versus losartan. We used data from the AVOID study and the Irbesartan in Diabetic Nephropathy Trial (IDNT) to estimate probabilities of progression of renal disease. We estimated probabilities of mortality for ESRD and other comorbidities using data from the US Renal Data System, US Vital Statistics, and published studies. We based pharmacy costs on wholesale acquisition costs and based costs of ESRD and transplantation on data from the US Renal Data System. We found that adding aliskiren to losartan increased time free of ESRD, life expectancy, and quality-adjusted life expectancy by 0.1772, 0.1021, and 0.0967 yr, respectively. Total expected lifetime health care costs increased by $2952, reflecting the higher pharmacy costs of aliskiren and losartan ($7769), which were partially offset by savings in costs of ESRD ($4860). We estimated the cost-effectiveness of aliskiren to be $30,500 per quality-adjusted life year gained. In conclusion, adding aliskiren to losartan and optimal therapy in patients with type 2 diabetes, hypertension, and albuminuria may be cost-effective from a US health care system perspective.
authors.affiliation: Policy Analysis, Inc, Brookline, Massachusetts 02445, USA. tdelea@pai2.com
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: Oleg
authors.initials: O
authors.lastname: Sofrygin
authors.forename: James L
authors.initials: JL
authors.lastname: Palmer
authors.forename: Helen
authors.initials: H
authors.lastname: Lau
authors.forename: Veronica C
authors.initials: VC
authors.lastname: Munk
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sung
authors.forename: Alan
authors.initials: A
authors.lastname: Charney
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D000419:Albuminuria / Q000188:drug therapy* / Q000191:economics; D000577:Amides / Q000627:therapeutic use*; D001713:Biphenyl Compounds / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy; D018450:Disease Progression; D005650:Fumarates / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics; D000077405:Irbesartan; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013777:Tetrazoles / Q000627:therapeutic use
chemical_list: D000577:Amides; D001713:Biphenyl Compounds; D005650:Fumarates; D013777:Tetrazoles; C446481:aliskiren; D000077405:Irbesartan; D019808:Losartan