title: Economic evaluations of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in type 2 diabetic nephropathy: a systematic review.
abstract: BACKGROUND
  Structured comparison of pharmacoeconomic analyses for ACEIs and ARBs in patients with type 2 diabetic nephropathy is still lacking. This review aims to systematically review the cost-effectiveness of both ACEIs and ARBs in type 2 diabetic patients with nephropathy.
  
  
  METHODS
  A systematic literature search was performed in MEDLINE and EMBASE for the period from November 1, 1999 to Oct 31, 2011. Two reviewers independently assessed the quality of the articles included and extracted data. All cost-effectiveness results were converted to 2011 Euros.
  
  
  RESULTS
  Up to October 2011, 434 articles were identified. After full-text checking and quality assessment, 30 articles were finally included in this review involving 39 study settings. All 6 ACEIs studies were literature-based evaluations which synthesized data from different sources. Other 33 studies were directed at ARBs and were designed based on specific trials. The Markov model was the most common decision analytic method used in the evaluations. From the cost-effectiveness results, 37 out of 39 studies indicated either ACEIs or ARBs were cost-saving comparing with placebo/conventional treatment, such as amlodipine. A lack of evidence was assessed for valid direct comparison of cost-effectiveness between ACEIs and ARBs.
  
  
  CONCLUSIONS
  There is a lack of direct comparisons of ACEIs and ARBs in existing economic evaluations. Considering the current evidence, both ACEIs and ARBs are likely cost-saving comparing with conventional therapy, excluding such RAAS inhibitors.
authors.affiliation: Department of Pharmacy, Unit of Pharmaco Epidemiology & Pharmaco Economics, University of Groningen, Groningen, The Netherlands. y.huang02@umcg.nl.
authors.forename: Yunyu
authors.initials: Y
authors.lastname: Huang
authors.forename: Qiyun
authors.initials: Q
authors.lastname: Zhou
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics*; D005062:European Union; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors