Cost-Effectiveness of Early Irbesartan Treatment Versus Control (Standard Antihypertensive Medications Excluding ACE Inhibitors, Other Angiotensin-2 Receptor Antagonists, and Dihydropyridine Calcium Channel Blockers) or Late Irbesartan Treatment in Patients With Type 2 Diabetes, Hypertension, and Renal Disease
- Andrew J. Palmer, BSC, MBBS1,
- Lieven Annemans, PHD23,
- Stéphane Roze, MS1,
- Mark Lamotte, MD2,
- Pablo Lapuerta, MD4,
- Roland Chen, MD4,
- Sylvie Gabriel, MD5,
- Paulo Carita, PHD5,
- Roger A. Rodby, MD6,
- Dick de Zeeuw, MD, PHD7 and
- Hans-Henrik Parving, MD8
- 1CORE-Center for Outcomes Research, Binningen/Basel, Switzerland
- 2HEDM, Health Economics and Disease Management, Meise, Belgium
- 3Ghent University, Ghent, Belgium
- 4Pharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, New Jersey
- 5Sanofi-Synthelabo, Bagneux, France
- 6Rush University Medical Center, Chicago, Illinois
- 7Department of Clinical Pharmacology, University Medical Center, Groningen, the Netherlands
- 8Steno Diabetes Center, Gentofte, Denmark
- Address correspondence and reprint requests to Dr. Andrew J. Palmer, CORE-Center for Outcomes Research, Buendtenmattstrasse 40, 4102 Binningen/Basel, Switzerland. E-mail: ap{at}thecenter.ch
Abstract
OBJECTIVE—The aim of this study was to determine the most cost-effective time point for initiation of irbesartan treatment in hypertensive patients with type 2 diabetes and renal disease.
RESEARCH DESIGN AND METHODS—This study was a Markov model–simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease, and death in hypertensive patients with type 2 diabetes. Two irbesartan strategies were created: early irbesartan 300 mg daily (initiated with microalbuminuria) and late irbesartan (initiated with overt nephropathy). These strategies were compared with control, which consisted of antihypertensive therapy with standard medications (excluding ACE inhibitors, other angiotensin-2 receptor antagonists, and dihydropyridine calcium channel blockers) with comparable blood pressure control, initiated at microalbuminuria. Transition probabilities were taken from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial, and other published sources. Costs and life expectancy, discounted at 3% yearly, were projected over 25 years for 1,000 simulated patients using a third-party payer perspective in a U.S. setting.
RESULTS—Compared with control, early and late irbesartan treatment in 1,000 patients were projected to save (mean ± SD) $11.9 ± 3.3 million and $3.3 ± 2.7 million, respectively. Early use of irbesartan added 1,550 ± 270 undiscounted life-years (discounted 960 ± 180), whereas late irbesartan added 71 ± 40 life-years (discounted 48 ± 27) in 1,000 patients. Early irbesartan treatment was superior under a wide-range of plausible assumptions.
CONCLUSIONS—Early irbesartan treatment was projected to improve life expectancy and reduce costs in hypertensive patients with type 2 diabetes and microalbuminuria. Later use of irbesartan in overt nephropathy is also superior to standard care, but irbesartan should be started earlier and continued long term.
- DSC, doubling of serum creatinine
- ESRD, end-stage renal disease
- IDNT, Irbesartan in Diabetic Nephropathy Trial
- IRMA-2, Irbesartan in Reduction of Microalbuminuria-2
- UAE, urinary albumin excretion
Footnotes
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A.J.P. and S.R. have received consulting fees and grant/research support from Bristol-Myers Squibb, Sanofi-Synthélabo, Eli Lilly, Novo Nordisk, Merck-Santé, Amgen, Amylin, Medtronic, Coloplast, and Janssen. L.A. has received grant support from Sanofi-Synthélabo. R.A.R. has received honoraria and consulting fees from Sanofi-Synthélabo and Bristol-Myers Squibb. D.D.Z. has received honoraria from BMS-Sanofi. H.-H.P. is on an advisory board for Sanofi-Synthélabo; has received honoraria/consulting fees from Sanofi-Synthélabo, Merck, BMS, and Pfizer; and has received grant support from Sanofi-Synthélabo.
U.S.-specific ESRD data have been taken from the U.S. Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted May 5, 2004.
- Received February 3, 2004.
- DIABETES CARE
