title: Prevention of renal failure in Chinese patients with newly diagnosed type 2 diabetes: A cost-effectiveness analysis.
abstract: OBJECTIVE
  Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease in China. The current study assessed the cost-effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes from the Chinese healthcare perspective.
  
  
  METHODS
  A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed type 2 diabetes might receive treatment according to one of the following three strategies: (i) "do nothing" strategy (control strategy); (ii) treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (universal strategy); (iii) or screening for microalbuminuria followed by angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment (screening strategy). Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results.
  
  
  RESULTS
  Compared with the control strategy, both the screening and universal strategies were cost-saving options that showed lower costs and better health benefits. The incremental cost-effectiveness ratio of the universal strategy over the screening strategy was US $30,087 per quality-adjusted life-year, which was higher than the cost-effectiveness threshold of China. The sensitivity analyses showed robust results, except for the probability of developing macroalbuminuria from microalbuminuria.
  
  
  CONCLUSIONS
  Screening for microalbuminuria could be a cost-saving option for the prevention of DKD in the Chinese setting.
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Suhua
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Houwen
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Shan
authors.identifier: http://orcid.org/0000-0002-7830-9345
authors.initials: S
authors.lastname: Mou
mesh_terms: D044466:Asian People; D002681:China; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000191:economics* / Q000517:prevention & control; D006801:Humans; D008390:Markov Chains; D051437:Renal Insufficiency / Q000150:complications / Q000191:economics* / Q000517:prevention & control
keywords: Cost-effectiveness; Diabetic kidney disease; Screening