Prevention of renal failure in Chinese patients with newly diagnosed type 2 diabetes: A cost-effectiveness analysis

Abstract

Aims/introduction: Diabetic kidney disease (DKD) is the second leading cause (16.4%) of end-stage renal disease in China. The current study assessed the cost-effectiveness of preventing DKD in patients with newly diagnosed type 2 diabetes from the Chinese healthcare perspective.

Materials and methods: A lifetime Markov decision model was developed according to the disease course of DKD. Patients with newly diagnosed type 2 diabetes might receive treatment according to one of the following three strategies: (i) "do nothing" strategy (control strategy); (ii) treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (universal strategy); (iii) or screening for microalbuminuria followed by angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker treatment (screening strategy). Clinical and utility data were obtained from the published literature. Direct medical costs and resource utilization in the Chinese healthcare setting were considered. Sensitivity analyses were undertaken to test the impact of a range of variables and assumptions on the results.

Results: Compared with the control strategy, both the screening and universal strategies were cost-saving options that showed lower costs and better health benefits. The incremental cost-effectiveness ratio of the universal strategy over the screening strategy was US $30,087 per quality-adjusted life-year, which was higher than the cost-effectiveness threshold of China. The sensitivity analyses showed robust results, except for the probability of developing macroalbuminuria from microalbuminuria.

Conclusions: Screening for microalbuminuria could be a cost-saving option for the prevention of DKD in the Chinese setting.

Keywords: Cost-effectiveness; Diabetic kidney disease; Screening.

Figure 1

Structure of the decision model with (a) a decision tree for the screening phase and (b) a Markov model for the long‐term disease course. During each Markov cycle, patients either remained in their assigned health state or progressed to a new health state (straight arrow). Transition rates between health states were derived either from systematic reviews of the literature or from previous studies. ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin II receptor blocker.

Figure 2

The cost‐effectiveness frontier shows the most efficient options among the three competing prevention strategies. The x‐axis shows the discounted lifetime quality‐adjusted life‐years (QALYs) for each strategy, and the y‐axis shows the total discounted lifetime costs (in US dollars). The oblique line connects interleukin‐2 and the most cost‐effective strategies; strategies above the straight lines were dominated or extended dominated. In the cost‐effective plane, the values of the most incremental cost‐effectiveness ratios (ICER) are shown.

Figure 3

Tornado diagram representing the cost per quality‐adjusted life‐year (QALY) gained in one‐way sensitivity analysis for universal strategy vs control strategy. The width of the bars represents the range of the results when the variables were changed. The vertical grey and black dotted lines represent the base‐case results and threshold, respectively. The width of the bars represents the range of results when the variables are changed. The vertical dotted line represents the base‐case results. ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin II receptor blocker; ESRD, end‐state renal disease; GDP, gross domestic product; HR, hazard ratio.

Figure 4

Cost‐effectiveness acceptability curves for the different strategies for preventing the diabetic kidney disease. The y‐axis shows the probability that a strategy is cost‐effective across the willingness to pay per quality‐adjusted life‐year (QALY) gained (x‐axis). The vertical dashed line represents the thresholds for China. GDP, gross domestic product.