The
Aliskiren in the Evaluation of
Proteinuria in Diabetes (AVOID) trial demonstrated that adding
aliskiren, an oral
direct renin inhibitor, at a dosage of 300 mg/d to the highest approved dosage of
losartan and optimal
antihypertensive therapy reduces
albuminuria over 6 mo among patients with
type 2 diabetes,
hypertension, and
albuminuria. The cost-effectiveness of this
therapy, however, is unknown. Here, we used a Markov model to project progression to
ESRD, life years, quality-adjusted life years, and lifetime costs for
aliskiren plus
losartan versus
losartan. We used data from the AVOID study and the
Irbesartan in
Diabetic Nephropathy Trial (IDNT) to estimate probabilities of progression of renal disease. We estimated probabilities of mortality for
ESRD and other comorbidities using data from the US Renal Data System, US Vital Statistics, and published studies. We based pharmacy costs on wholesale acquisition costs and based costs of
ESRD and
transplantation on data from the US Renal Data System. We found that adding
aliskiren to
losartan increased time free of
ESRD, life expectancy, and quality-adjusted life expectancy by 0.1772, 0.1021, and 0.0967 yr, respectively. Total expected lifetime health care costs increased by $2952, reflecting the higher pharmacy costs of
aliskiren and
losartan ($7769), which were partially offset by savings in costs of
ESRD ($4860). We estimated the cost-effectiveness of
aliskiren to be $30,500 per quality-adjusted life year gained. In conclusion, adding
aliskiren to
losartan and optimal
therapy in patients with
type 2 diabetes,
hypertension, and
albuminuria may be cost-effective from a US health care system perspective.