A cost-effectiveness analysis of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in diabetic nephropathy

Abstract

The aim of this study was to estimate the cost-effectiveness of renin-angiotensin-aldosterone system blockers in patients with diabetic nephropathy. A cost-effectiveness analysis was performed based on a meta-analysis of studies investigating the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) as part of a treatment regimen on the incidence of end-stage renal disease (ESRD) in patients with diabetic nephropathy. The primary outcome was the cost to prevent 1 patient from developing ESRD. Cost analysis was performed from a third-party payer perspective in 2006 US dollars. As part of a treatment regimen, ARBs significantly reduced the incidence of ESRD and doubling of serum creatinine concentration (P<.05) but not total mortality. The cost to prevent 1 patient from developing ESRD was $31,729 (95% confidence interval, $19,443-$85,442; P<.01), $189,190 (P=.13) and $51,585 (P=.068) for patients receiving ARBs, ACE inhibitors, or either of them, respectively. This study demonstrates that blocking the RAAS, which delays the progression to ESRD, appears to be cost-effective. The current analysis favors ARBs in terms of cost-effectiveness.

Figure 1

Effect of angiotensin‐converting enzyme (ACE) inhibitor‐based or angiotensin receptor blocker (ARB)‐based therapy compared with regimens without renin‐angiotensin‐aldosterone system (RAAS) inhibitors on renal outcomes (end‐stage renal disease [ESRD] and doubling of serum creatinine concentration). RR indicates relative risk; CI, confidence interval.

Figure 2

Risk difference of angiotensin‐converting enzyme (ACE) inhibitor‐based or angiotensin receptor blocker (ARB)‐based treatment compared with regimens without renin‐angiotensin‐aldosterone system (RAAS) blockade on incidence of end‐stage renal disease (ESRD). RD indicates risk difference; CI, confidence interval.