title: Cost-effectiveness of angiotensin-converting enzyme inhibitors in nondiabetic advanced renal disease.
abstract: BACKGROUND
  National and international clinical guidelines do not consistently recommend treating nondiabetic proteinuric patients with advanced renal disease with an angiotensin-converting enzyme (ACE) inhibitor.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of ACE inhibitor therapy in nondiabetic proteinuric patients with advanced renal disease in Germany.
  
  
  METHODS
  Two strategies were compared: treating patients with advanced renal disease with an ACE inhibitor and no ACE inhibitor treatment. A lifetime Markov decision model was developed using published data on costs and health outcomes and simulated the progression of renal disease with costs and benefits discounted at 3%. A statutory health insurance perspective was adopted.
  
  
  RESULTS
  In the base-case analysis, ACE inhibitor treatment is associated with lower costs and higher benefit and therefore dominates the no-treatment strategy. A probabilistic sensitivity analysis demonstrates that the probability of savings is 80%.
  
  
  CONCLUSIONS
  ACE inhibitor treatment for nondiabetic patients with advanced renal disease is highly cost effective.
authors.affiliation: Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany.
authors.forename: Charles Christian
authors.initials: CC
authors.lastname: Adarkwah
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D008390:Markov Chains; D011336:Probability; D011507:Proteinuria / Q000188:drug therapy
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors