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A French cost-consequence analysis of the renoprotective benefits of irbesartan in patients with type 2 diabetes and hypertension

journal contribution
posted on 2023-05-17, 09:27 authored by Andrew PalmerAndrew Palmer, Valentine, WJ, Tucker, DMD, Ray, JA, Roze, S, Annemans, L, Lapuerta, P, Chen, R, Gabriel, S, Carita, P, Rodby, RA, de Zeeuw, D, Parving, HH, Laville, M
Objectives: We performed a cost-consequence analysis in a French setting of the renoprotective benefit of irbesartan in hypertensive type 2 diabetes patients over a 25-year period. Research design and methods: A previously published Markov model simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease and death. Three treatment strategies with analogous blood pressure control were compared: (A) control - conventionally medicated antihypertensive therapy (excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers) initiated at microalbuminuria; (B) early irbesartan - (300 mg daily added to control, initiated with microalbuminuria) and (C) late irbesartan - (300 mg daily, initiated with overt nephropathy). Probabilities came from the Irbesartan in Reduction of Microalbuminuria-2 study, Irbesartan in Diabetic Nephropathy Trial and other sources. Clinical and economic outcomes were projected over 25 years. Annual discount rates were 3%. Results: Compared to control, early use of irbesartan added (mean ± standard deviation) 1.51 ± 0.08 undiscounted life years (discounted: 0.94 ± 0.05 years), while late irbesartan added 0.07 ± 0.01 (0.04 ± 0.01) years/patient. Early irbesartan added 1.03 ± 0.06 discounted quality-adjusted life years (QALYs), while late irbesartan added 0.06 ± 0.01 QALYs. Early and late irbesartan treatments were projected to save €22314 ± 1273 and €6619 ± 820/patient, respectively versus control. Sensitivity analysis showed that even over short time horizons both irbesartan treatments were superior to the control group. Conclusions: In France, early irbesartan treatment improved quality and length of life and reduced costs in hypertensive patients with type 2 diabetes and microalbuminurla. Late irbesartan therapy is beneficial, but earlier irbesartan leads to better outcomes. © 2006 Librapharm Limited.


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Current Medical Research and Opinion










Menzies Institute for Medical Research



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