A French cost-consequence analysis of the renoprotective benefits of irbesartan in patients with type 2 diabetes and hypertension.

Abstract

OBJECTIVES:

We performed a cost-consequence analysis in a French setting of the renoprotective benefit of irbesartan in hypertensive type 2 diabetes patients over a 25-year period.

RESEARCH DESIGN AND METHODS:

A previously published Markov model simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease and death. Three treatment strategies with analogous blood pressure control were compared: (A) control--conventionally medicated antihypertensive therapy (excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers) initiated at microalbuminuria; (B) early irbesartan--(300 mg daily added to control, initiated with microalbuminuria) and (C) late irbesartan--(300 mg daily, initiated with overt nephropathy). Probabilities came from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial and other sources. Clinical and economic outcomes were projected over 25 years. Annual discount rates were 3%.

RESULTS:

Compared to control, early use of irbesartan added (mean +/- standard deviation) 1.51 +/- 0.08 undiscounted life years (discounted: 0.94 +/- 0.05 years), while late irbesartan added 0.07 +/- 0.01 (0.04 +/- 0.01) years/patient. Early irbesartan added 1.03 +/- 0.06 discounted quality-adjusted life years (QALYs), while late irbesartan added 0.06 +/- 0.01 QALYs. Early and late irbesartan treatments were projected to save 22,314 +/- 1273 euro and 6619 +/- 820 euro/patient, respectively versus control. Sensitivity analysis showed that even over short time horizons both irbesartan treatments were superior to the control group.

CONCLUSIONS:

In France, early irbesartan treatment improved quality and length of life and reduced costs in hypertensive patients with type 2 diabetes and microalbuminuria. Late irbesartan therapy is beneficial, but earlier irbesartan leads to better outcomes.

• Authors: Andrew J Palmer, William J Valentine, Daniel M D Tucker, Joshua A Ray, Stéphane Roze, Lieven Annemans, Pablo Lapuerta, Roland Chen, Sylvie Gabriel, Paulo Carita, Roger A Rodby, Dick de Zeeuw, Hans-Henrik Parving, Maurice Laville
• Journal: Current medical research and opinion (Curr Med Res Opin) Vol. 22 Issue 11 Pg. 2095-100 (Nov 2006) ISSN: 1473-4877 [Electronic] England
• PMID: 17076969 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Biphenyl Compounds
• Tetrazoles
• Irbesartan

Topics

• Albuminuria (complications, drug therapy)
• Angiotensin II Type 1 Receptor Blockers (administration & dosage, economics, therapeutic use)
• Biphenyl Compounds (administration & dosage, economics, therapeutic use)
• Cost-Benefit Analysis
• Diabetes Mellitus, Type 2 (complications)
• Diabetic Angiopathies (complications, drug therapy)
• Diabetic Nephropathies (drug therapy, etiology, prevention & control)
• Disease Progression
• Drug Administration Schedule
• France
• Health Care Costs
• Humans
• Hypertension (complications, drug therapy)
• Irbesartan
• Kidney Failure, Chronic (drug therapy)
• Markov Chains
• Quality-Adjusted Life Years
• Tetrazoles (administration & dosage, economics, therapeutic use)
• Treatment Outcome