Original Article

Kidney International (2005) 67, S52–S54; doi:10.1111/j.1523-1755.2005.09312.x

Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria

ANDREW J PALMER, LIEVEN ANNEMANS, STÉPHANE ROZE, PABLO LAPUERTA, ROLAND CHEN, SYLVIE GABRIEL, PAULO CARITA, ROGER A RODBY, DICK DE ZEEUW, HANS-HENRIK PARVING and FERNANDO DE ALVARO

CORE—Center for Outcomes Research, Binningen/Basel, Switzerland; HEDM, Health Economics and Disease Management, Meise, Belgium; Ghent University, Ghent, Belgium; Pharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, New Jersey; Sanofi-Synthelabo, Bagneux, France; Rush University Medical Center, Chicago, Illinois; Department of Clinical Pharmacology; University Medical Center, Groningen, The Netherlands; Steno Diabetes Center, Gentofte, Denmark; and Servicio de Nefrologia, Hospital La Paz, Madrid

Correspondence: Dr Andrew J. Palmer, CORE—Center for Outcomes Research, Buendtenmattstrasse 40, 4102 Binningen/Basel, Switzerland

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Abstract

Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria.

Objectives

 

The purpose of this study was to project the cumulative incidence of end-stage renal disease (ESRD), life expectancy, and costs in a Spanish setting of treating patients with diabetes, hypertension, and microalbuminuria with either standard hypertension treatment alone or standard hypertension treatment plus irbesartan 300 mg daily.

Methods

 

A peer-reviewed, published Markov model that simulated progression from microalbuminuria to nephropathy, doubling of serum creatinine, ESRD, and all-cause mortality in patients with hypertension, type 2 diabetes, and microalbuminuria was adapted to a Spanish setting. Two strategies were compared: (1) irbesartan versus (2) standard hypertension care with comparable blood pressure control; both began in diabetic hypertensive subjects with microalbuminuria. Cumulative incidence of ESRD, costs, and life expectancy were projected for a hypothetical cohort of 1000 subjects. Future costs and life expectancy were discounted at 3% yearly. A 25-year time horizon and third party payer perspective were used.

Results

 

When compared to standard blood pressure control, irbesartan was projected to reduce the cumulative incidence of ESRD from (mean plusminus standard deviation) 24 plusminus 1% to 9 plusminus 2%, save euro dollar11,082 plusminus 2,996, and add 1.40 plusminus 0.27 life years per treated patient. The superiority of irbesartan over standard care was robust under a wide range of plausible assumptions.

Conclusion

 

Treating patients with hypertension, microalbuminuria, and type 2 diabetes with irbesartan was projected to reduce the incidence of ESRD, extend life, and reduce costs.

Keywords:

irbesartan, costs, cost-effectiveness, microalbuminuria, nephropathy, modeling, end-stage renal disease, Spain

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