Key result
Angiotensin receptor blockers were cost-effective for preventing end-stage renal disease in diabetic nephropathy, costing $31,729 per case prevented (95% CI, $19,443-$85,442; P<.01).
Why the study?
Are ACE inhibitors and ARBs cost-effective in preventing end-stage renal disease in patients with diabetic nephropathy?
Meta-Analysis
Are ACE inhibitors and ARBs cost-effective in preventing end-stage renal disease in patients with diabetic nephropathy?
Effect estimate: Cost $31,729 for ARBs (95% CI 19,443-85,442)
p-value: p=<.01
ARBs appear to be a cost-effective strategy for preventing end-stage renal disease in patients with diabetic nephropathy.
Supports ARB use to prevent ESRD in diabetic nephropathy at acceptable cost; extends efficacy data with economic confirmation from meta-analysis.
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.
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Stafylas et al. (2007) conducted a meta-analysis in diabetic nephropathy. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) was evaluated on cost to prevent 1 patient from developing ESRD (Cost $31,729 for ARBs, 95% CI 19,443-85,442, p=<.01). Angiotensin receptor blockers were cost-effective for preventing end-stage renal disease in diabetic nephropathy, costing $31,729 per case prevented (95% CI, $19,443-$85,442; P<.01).
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