Clinical and health economic implications of early treatment with irbesartan of patients with type 2 diabetes mellitus, hypertension and nephropathy
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Palmer, AJ and Roze, S and Rodby, RA and Valentine, WJ and Ritz, E and Lehnert, H, Clinical and health economic implications of early treatment with irbesartan of patients with type 2 diabetes mellitus, hypertension and nephropathy, Deutsche Medizinische Wochenschrift, 131, (31-32) pp. 1721-1726. ISSN 0012-0472 (2006) [Refereed Article]
Background and Objective: It was the aim of this study to project the long-term clinical and cost outcomes of irbesartan treatment, based on data from the irbesartan in Reduction of Microalbuminuria-2 (IRMA-2) study and the irbesartan in Diabetic Nephropathy Trial (IDNT), in hypertensive patients with type 2 diabetes and renal disease in Germany. Patients and Methods: A Markov model adapted to the German setting simulated progression of renal disease and associated changes in mortality in patients with hypertension, type 2 diabetes and microalbuminuria. Early irbesartan 300 mg daily (initiated at microalbuminuria) and late irbesartan (initiated at overt nephropathy) were compared to a control scheme of antihypertensive standard medications with comparable blood pressure control, initiated at microalbuminuria. Cumulative incidence of ESRD, time to onset of ESRD, life expectancy (LE), quality-adjusted life years (QALY) and costs were projected over 25 years for 1,000 simulated patients, from a third party payer perspective. Clinical and cost outcomes were discounted at 5% per annum. Results: When compared to standard blood pressure control, both early and late treatment with irbesartan were projected to reduce the cumulative incidence of ESRD fromm23.8±0.3% to 9.1±0.6% and 19.8±3%, increase discounted LE by 0.67±0.04 and 0.03±0.00 years, and improve QALY by 0.75±0.04 and 0.07±0.01 years per treated patient, respectively. Early irbesartan treatment was associated with a cost savings of € 12,658±825 per patient while late irbesartan treatment was associated with a cost savings of € 4,116±575 per patient compared to control over the 25-year time horizon. Conclusions: Early irbesartan treatment was projected to improve LE and QALY, and reduce the onset of ESRD, with cost savings, in hypertensive patients with type 2 diabetes and microalbuminuria in Germany. Later use of irbesartan in overt nephropathy is also superior to standard care. These findings suggest that irbesartan should be started earlier and continued long-term. © Georg Thieme Verlag KG Stuttgart.
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