gms | German Medical Science

10. Deutscher Kongress für Versorgungsforschung, 18. GAA-Jahrestagung

Deutsches Netzwerk Versorgungsforschung e. V.
Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e. V.

20.-22.10.2011, Köln

Cost-effectiveness of angiotensin-converting enzyme inhibitors for the prevention of diabetic nephropathy in the Netherlands – a Markov model

Meeting Abstract

  • corresponding author presenting/speaker Charles Christian Adarkwah - CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
  • Afschin Gandjour - Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, USA
  • Maren Akkerman - Faculty of Medicine, RWTH-University Aachen, Aachen, Germany
  • Silvia Evers - CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands

10. Deutscher Kongress für Versorgungsforschung. 18. GAA-Jahrestagung. Köln, 20.-22.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dkvf040

doi: 10.3205/11dkvf040, urn:nbn:de:0183-11dkvf0404

Veröffentlicht: 12. Oktober 2011

© 2011 Adarkwah et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Type 2 diabetes is the main cause of end-stage renal disease (ESRD) in the Netherlands [1] as well as in other European countries and the United States [2], [3]. Angiotensin-converting enzyme (ACE) inhibitors have a potential to slow down the progression of renal disease and therefore provide a renal-protective effect [4], [5]. The aim of our study was to assess the most cost-effective time to start an ACE inhibitor (or an angiotensin II receptor blocker (ARB) if coughing as a side effect occurs) in patients with newly diagnosed type 2 diabetes in the Netherlands.

Methods: A lifetime Markov decision model with simulated 50-year-old patients with newly diagnosed diabetes mellitus was developed using published data on costs and health outcomes and simulating the progression of renal disease. A health insurance perspective was adopted.

Three strategies were compared: treating all patients at the time of diagnosing type 2 diabetes, screening for microalbuminuria, and screening for macroalbuminuria.

Results: In the base-case analysis, the treat-all strategy is associated with the lowest costs and highest benefit and therefore dominates screening both for macroalbuminuria and microalbuminuria. A multivariate sensitivity analysisshows that the probability of savings is 70%.

Conclusions: In the Netherlands patients with type 2 diabetes should receive an ACE inhibitor immediately after diagnosis if they do not have contraindications. An ARB should be considered for those patients developing a dry cough under ACE inhibitor therapy. The potential for cost savings would be even larger if the prevention of cardiovascular events were considered.


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