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Cost-effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in newly diagnosed type 2 diabetes in Germany

Published online by Cambridge University Press:  08 January 2010

Charles Christian Adarkwah  and
Afschin Gandjour
Charles Christian Adarkwah
Affiliation:
University of Cologne, Cologne and RWTH-University Hospital Aachen
Afschin Gandjour
Affiliation:
Pennington Biomedical Research Center/Louisiana State University and Rice University and University of Cologne
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Abstract

Objectives: Type 2 diabetes is the main cause of end-stage renal disease in Europe and the United States. Angiotensin-converting enzyme (ACE) inhibitors slow down the progression of renal disease and, therefore, provide a renal-protective effect. The aim of this study was to assess the most cost-effective time to start an ACE inhibitor (or an angiotensin II receptor blocker in the event of cough) in patients with type 2 diabetes in Germany.

Methods: Three strategies were compared: treating all patients at the time of diagnosing type 2 diabetes, screening for microalbuminuria, and screening for macroalbuminuria. 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 statutory health insurance perspective was adopted.

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 analysis shows that the probability of savings is 89 percent.

Conclusions: Patients with type 2 diabetes should receive an ACE inhibitor immediately after diagnosis if they do not have contraindications. The potential for cost savings would be even larger if the prevention of cardiovascular events were considered.

Keywords

Type 2 diabetes mellitusCost-effectivenessDecision modelingAngiotensin-converting enzyme inhibitorsAngiotensin II receptor blockersScreening
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 1 , January 2010 , pp. 62 - 70
Copyright
Copyright © Cambridge University Press 2010

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