title: To treat or not to treat? Cost-effectiveness of ace inhibitors in non-diabetic advanced renal disease - a Dutch perspective.
abstract: BACKGROUND
  Treating non-diabetic proteinuric patients with advanced renal disease with an angiotensin-converting enzyme (ACE) inhibitor is still subject to discussion. This study aims to determine the cost-effectiveness of ACE inhibitor therapy in this patient population in the Netherlands.
  
  
  METHODS
  We compared two strategies: first, treating patients with advanced renal disease with an ACE inhibitor and no-treatment. A lifetime Markov decision model was developed simulating the progression of renal disease and using published data on costs and health outcomes. A health care perspective was adopted.
  
  
  RESULTS
  In the base-case analysis, treatment with ACE inhibitors leads to higher benefits and lower costs and dominates the no-treatment strategy. Sensitivity analysis shows that the probability of savings is 83%.
  
  
  CONCLUSIONS
  ACE inhibitor treatment for non-diabetic patients with advanced renal disease in the Netherlands is highly cost-effective and should therefore be considered.
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, 6229 GT Maastricht, The Netherlands. c.adarkwah@maastrichtuniversity.nl
authors.forename: Charles Christian
authors.initials: CC
authors.lastname: Adarkwah
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
authors.forename: Maren
authors.initials: M
authors.lastname: Akkerman
authors.forename: Silvia
authors.initials: S
authors.lastname: Evers
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D016527:Drug Costs; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011507:Proteinuria / Q000378:metabolism; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine