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

Curr Med Res Opin. 2006 Nov;22(11):2095-100. doi: 10.1185/030079906X132730.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

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

Substances

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