Artikel
Cost-effectiveness of angiotensin-converting enzyme inhibitors for the prevention of diabetic nephropathy in the Netherlands – a Markov model
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Veröffentlicht: | 12. Oktober 2011 |
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Gliederung
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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.
References
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