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

Authors: Palmer, Andrew J.¹; Valentine, William J.¹; Tucker, Daniel M.D.¹; Ray, Joshua A.¹; Roze, Stéphane¹; Annemans, Lieven²; Lapuerta, Pablo³; Chen, Roland³; Gabriel, Sylvie⁴; Carita, Paulo⁴; Rodby, Roger A.⁵; de Zeeuw, Dick⁶; Parving, Hans-Henrik⁷; Laville, Maurice⁸

Source: Current Medical Research and Opinion, Volume 22, Number 11, November 2006 , pp. 2095-2100(6)

Publisher: Informa Healthcare

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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 and €6619 ± 820/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.

Keywords: COSTS; DIABETES; FRANCE; HYPERTENSION; IRBESARTAN; NEPHROPATHY

Document Type: Case report

DOI: 10.1185/030079906X132730

Affiliations: 1: CORE - Center for Outcomes Research, Allschwil/Basel, Switzerland 2: IMS-HEDM, Meise, Belgium; Ghent University, Ghent, Belgium 3: Pharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, NJ, USA 4: Sanofi-Aventis, Bagneux, France 5: Rush University Medical Center, Chicago, USA 6: Department of Clinical Pharmacology, University Medical Center, Groningen, the Netherlands 7: Steno Diabetes Center, Gentofte, Denmark 8: Department of Nephrology, Edouard Herriot Hospital, Lyon, France

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