Background
Methods
Literature search strategy
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Indicating target drugs, the variations in and abbreviations of ACEIs and ARBs were searched, such as ‘angiotensin receptor antagonists’ , ‘renin angiotensin aldosterone system inhibitors’, and specific drug names of different ACEIs or ARBs, including 10 specific ACEIs (such as captopril, enalapril, etc.) and 8 ARBs (such as losartan, irbesartan, etc.).
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Indicating diabetic nephropathy, key words were limited to ‘type 2 diabetes’ and its variations. Variations of nephropathy were combined with diabetes, such as ‘diabetic renal diseases’ or ‘diabetic kidney diseases’.
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Indicating economic evaluations, various key words relating to different evaluation types, pharmacoeconomics, cost of drugs and cost analysis were searched, including ‘cost-effectiveness analysis’ (CEA), ‘cost-utility analysis’ (CUA), ‘cost-benefit analysis’ (CBA), and ‘cost savings’, etc.Table 1Search terms for systematic reviewSearch termsMEDLINEEMBASEDrugMesh: Angiotensin-Converting Enzyme Inhibitors; Angiotensin Receptor Antagonists;EMtree: dipeptidyl carboxypeptidase inhibito; angiotensin receptor antagonist;TIAB (Title and Abstract): ACEIs; ARBs; ACEI; ARB; renin angiotensin system inhibitor*a; renin angiotensin aldosterone system inhibitor*; ACE inhibitor*; RAS inhibitor*; RAAS inhibitor*; angiotensin converting enzyme inhibitor*; renin angiotensin system inhibitor*; angiotensin receptor blocker*; Losartan; Candesartan; Valsartan; Irbesartan; Telmisartan; Eprosartan; Olmesartan; Azilsartan; Benazepril; Captopril; Enalapril; Fosinopril; Lisinopril; Moexipril; Perindopril; Quinapril; Ramipril; Trandolaprilab,ti (Abstract and Title): angiotensin receptor blocker; angiotensin receptor blockers; arb; arbs; ace inhibitor; ace inhibitors; angiotensin converting enzyme inhibitor; angiotensin converting enzyme inhibitors; angiotensin converting enzyme (ace) inhibitor; angiotensin converting enzyme (ace) inhibitors; acei; aceis; renin angiotensin system inhibitor; renin angiotensin system inhibitors; renin angiotensin system (ras) inhibitor; renin angiotensin system (ras) inhibitors; ras inhibitor; ras inhibitors; renin angiotensin aldosterone system inhibitor; renin angiotensin aldosterone system inhibitors; raas inhibitor; raas inhibitors; losartan; candesartan; valsartan; irbesartan; telmisartan; eprosartan; olmesartan; azilsartan; benazepril; captopril; enalapril; fosinopril; lisinopril; moexipril; perindopril; quinapril; ramipril; trandolapril;Diabetic Nephropathy (DN)Mesh: Diabetes Mellitus, Type 2; Diabetic Nephropathies; Kidney Failure, Chronic;EMtree: non insulin dependent diabetes mellitus; diabetic nephropathy;TIAB: diabetic nephropathy*; diabetic renal disease*; diabetic kidney disease*;ab,ti: diabetic nephropathy; diabetic nephropathies; diabetic renal diseases; diabetic renal disease; diabetic kidney diseases; diabetic kidney diseaseEconomic Evaluation (EE)Mesh: Economics, Pharmaceutical; Costs and Cost Analysis; Drug Costs; Cost Savings; Cost of Illness; Cost-Benefit Analysis;EMtree: pharmacoeconomics; economic evaluation; drug cost; cost control; cost of illness; cost benefit analysis; cost effectiveness analysis;TIAB: cost effect*; cost utility; cost benefit*; economic evaluation*; cost analys*ab,ti: cost effectiveness; cost utility; cost benefit; economic evaluation; economic evaluations; cost analys;Search Strategy(“Drug Term 1”[Mesh] OR “Drug Term 2”[TIAB] …) AND (“DN Term 1”[Mesh] OR “DN Term 2”[TIAB] …) AND (“EE Term 1”[Mesh] OR “EE Term 2”[TIAB] …)(‘Drug Term 1’/exp OR ‘Drug Term 2’:ab,ti …) AND (‘DN Term 1’/exp OR ‘DN Term 2’:ab,ti …) AND (‘EE Term 1’/exp OR ‘EE Term 2’:ab,ti …) NOT [medline]/lim b
Study selection
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Population: patients in studies had to have type 2 diabetes with symptoms of renal diseases;
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Interventions and Comparators: studies must examine an ACEI- or ARB-based treatment regimen for the progression of diabetic nephropathy compared with regimens that did not include these medications, or if available, compare ACEIs with ARBs directly;
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Outcomes: clinical outcomes should be relevant to renal disease symptoms, including overt diabetic nephropathy, ESRD (kidney transplantation or dialysis), all-cause mortality, etc.; and
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Study design: studies had to be original economic evaluations.
Quality assessment
Data extraction
Results
Summary of selected studies
ACEIs (total 6) | ARBs (total 33) | ARBs Losartan (total 14) | ARBs Irbesartan (total 18) | ARBs Valsartan (total 1) | ||
---|---|---|---|---|---|---|
Data source | Trial based | 0 | 33 | 14 | 18 | 1 |
Literature based | 6 | 0 | 0 | 0 | 0 | |
Intervention and control group | Comparing with placebo/conventional therapy | 2 | 22 | 14 | 8 | 0 |
Comparing with other drugs | 0 | 12 | 0 | 11 | 1 | |
Comparing different strategies | 4 | 10 | 0 | 10 | 0 | |
Decision model | Markov model | 6 | 20 | 1 | 18 | 1 |
Weibull model | 0 | 3 | 3 | 0 | 0 | |
Regression method | 0 | 10 | 10 | 0 | 0 | |
Perspective | Third party payer | 4 | 33 | 14 | 18 | 1 |
Societal | 2 | 0 | 0 | 0 | 0 | |
CE results | Cost-saving | 5 | 32 | 13 | 18 | 1 |
Cost-neutral | 0 | 1 | 1 | 0 | 0 | |
Very cost-effective | 1 | 0 | 0 | 0 | 0 | |
Cost-effective | 0 | 0 | 0 | 0 | 0 | |
Not cost-effective | 0 | 0 | 0 | 0 | 0 |
Design of selected studies
Study, country/region | Source of effectiveness data | Intervention group | Control group | Decision model type | Time horizon (years) | Evaluation type |
---|---|---|---|---|---|---|
ACEIs
| ||||||
Golan et al. 1999 US [33] | UERNN, LEAPP and EADN trial | ‘Treat all’ strategya
| (1) Screen for MiAb; | Markov model with 5 states | 10 | CEA & CUA (Life-years & QALYs) |
(2) Screen for gross proteinuriac. | ||||||
Sakthong et al. 2001 Thailand [34] | LEAN trial and the opinion of nephrologists | Enalapril at the dose of 10 mg/day | Placebo | Markov model with 4 stages | 25 | CEA (Life years) |
Rosen et al. 2005 US [35] | UERNN, EADN, LEAN, H-MH studies and HOPE trial | Medicare first-dollar coverage of ACEIs | Year 2005’s Medicare practice | Markov model adding a cardiovascular events component. | lifetime | CEA & CUA (Life-years & QALYs) |
Campbell et al. 2007 US [36] | UERNN, EADN, H-MH studies and IRMA-2 trial | ACEI therapy in normoalbuminimuric, microalbuminuric, and macroalbuminuric patients | No ACEI initiation in patients | Markov model | 8 | CEA (CVD event avoided, life saved, dialysis prevented, composite endpoint avoided) |
Adarkwah et al. 2010 Germany [37] | EADN and two meta-analyses | ‘Treat all’ strategya
| (1) Screen for MiAb; | Markov model with 5 states | 50 | CUA (QALY) |
(2) Screen for MaAc; | ||||||
(3) no-screening and no-treatment alternative. | ||||||
Adarkwah et al. 2011 Netherlands [38] | EADN and two meta-analyses | ‘Treat all’ strategya
| (1) Screen for MiAb; | Markov model with 5 states | 50 | CUA (QALY) |
(2) Screen for MaAc. | ||||||
ARBs
| ||||||
Losartan
| ||||||
Herman et al. 2003 US [39] | RENAAL trial | Losartan | Placebod
| A regression-based method | 3.5 / 4 | CEA (Number of ESRD days) |
Souchet et al. 2003 France [40] | RENAAL trial | Losartan (initial daily dosing of losartan was 50 mg, with the possibility of titration to 100 mg/day) | Placebod
| A regression-based method | 3.5 / 4 | CEA (Number of ESRD days) |
Burgess et al. 2004 Canada [41] | RENAAL trial | Losartan | Placebod
| A regression-based method | 3.5 / 4 | CEA (Number of ESRD days) |
Szucs et al. 2004 Switzerland [42] | RENAAL trial | Losartan (initial daily dosing of losartan was 50 mg, with the possibility of titration to 100 mg/day) | Placebod
| A regression-based method | 3.5 / 4 | CEA (Number of ESRD days) |
Seng et al. 2005 Hong Kong [32] (only data of Hong Kong were included) | RENAAL trial | Losartan | Placebod
| A regression-based method | 3.5 | CEA (Number of ESRD days) |
Arredondo et al. 2005 Mexico [43]]
| RENAAL trial | Losartan | Placebod
| A variation of the cumulative incidence competing risk method / Weibull model | 25 (life time) | CEA (Cumulative incidence of ESRD, life expectancy) |
Vora et al. 2005 UK [44] | RENAAL trial | Losartan (50–100 mg QD) | Conventional antihypertensive treatmentd (excluding ACEIs or angiotensin II antagonists) | Weibull model | life time | CEA (Cumulative incidence of ESRD, life expectancy) |
Carides et al. 2006 US [45] | RENAAL trial | Losartan | Placebod
| A cumulative incidence competing risk method / Weibull model | 25 (life time) | CEA (Cumulative incidence of ESRD, life expectancy) |
Stafylas et al. 2007 Greece [46] | RENAAL trial | Losartan (50–100 mg QD) | Placebod
| Markov model with 6 states | 3.5/4 | CEA (Number of ESRD days) |
de Portu et al. 2011 Italy, France, Germany, Switzerland, US [47] | RENAAL trial | Losartan | Standard cared
| Standard methods by comparing the economic outcomes deriving from additional losartan to standard care vs standard care alone | 3.4 | CEA (Number of ESRD days) |
Irbesartan
| ||||||
Rodby RA et al. 2003 US [48] | IDNT trial | Irbesartan titrated from 75 to 300 mg/day | (1) ‘Control’d; | Markov model with 5 stages | 25 | CEA (Life expectancy) |
(2) Amlodipine titrated from 2.5 to 10 mg/day. | ||||||
Palmer AJ et al. 2003 Belgium, France [49] | IDNT trial | Irbesartan titrated from 75 to 300 mg/day | (1) ‘Control’d; | Markov model with 5 stages | 25 | CEA (Life expectancy) |
(2) Amlodipine titrated from 2.5 to 10 mg/day. | ||||||
Coyle D et al. 2004 Canada [50] | IDNT trial | Irbessartan | (1) Amlodipine; | Markov model with 5 stages | 25 | CEA (Life expectancy) |
(2) Standard cared
| ||||||
Palmer AJ et al. 2004 UK [51] | IDNT trial | Irbesartan 300 mg per day | (1) ‘Control’d; | Markov model with 5 stages | 25 | CEA (Life expectancy) |
(2) Amlodipine 10 mg per day. | ||||||
Palmer AJ et al. 2004 US [52] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| (1) ‘Control’d; | Markov model with 7 stages | 25 | CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
(2) ‘Late irbesartan’f
| ||||||
Palmer AJ et al. 2005 Spain [53] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| Standard antihypertensive medicationsd
| Markov model with 7 stages | 25 | CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
Palmer AJ et al. 2006 Switzerland [54] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| Conventional antihypertensive treatmentd initiated when patients had developed MiA. | Markov model with 7 stages | 25 | CEA (Years free of ESRD, cumulative incidence of ESRD, life expectancy) |
Palmer AJ et al. 2006 France [55] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| (1) ‘Control’d; | Markov model with 7 stages | 25 | CEA & CUA (Years free of ESRD, life expectancy, QALY) |
(2) ‘Late irbesartan’f
| ||||||
Palmer AJ et al. 2007 Hungary [56] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| ‘Placebo’d: standard antihypertensive medications initiated when patients developed MiA. | Markov model with 7 stages | 25 | CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
Palmer AJ et al. 2007 UK [57] | IRMA-2 study and IDNT trial | ‘Early irbesartan’e
| (1) ‘Control’d; | Markov model with 7 stages | 25 | CEA (Years free of ESRD, cumulative Incidence of ESRD, life expectancy) |
(2) ‘Late irbesartan’f
| ||||||
Coyle D et al. 2007 Canada [58] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| (1) ‘Late irbesartan’f; | Markov model with 7 stages | 25 | CEA (Life expectancy) |
(2) ‘Conventional’d
| ||||||
Yang W.C. et al. 2007 Taiwan [59] | IRMA-2 study and IDNT | ‘Early irbesartan’e
| (1) ‘Standard’d; | Markov model with 7 stages | 25 | CEA (Life expectancy, number of years free of ESRD, cumulative incidence of ESRD) |
(2) ‘Late irbesartan’f; | ||||||
(3) ‘Late amlodipine’g
| ||||||
Annemans et al. 2008 China, Taiwan, Malaysia, Thailand, South Korea [60] | IRMA-2 study and IDNT trial | ‘Early irbesartan’e
| (1) ‘Standard’d; | Markov model with 7 stages | 25 | CEA (Cumulative incidence of ESRD, number of days in dialysis, number of years free of ESRD, life expectancy) |
(2) ‘Late irbesartan’f; | ||||||
(3) ‘Late amlodipine’g
| ||||||
Valsartan
| ||||||
Smith DG et al. 2004 US [61] | MARVAL study | Valsartan | Amlodipine | Markov model with 7 stages | 8 | CUA (Quality-adjusted survival) |
ACEIs
ARBs
Cost-effectiveness results
Study, country/ region | Discount rate (per annum) | Perspective | Cost categories | Discounted life expectancy/QALY | Incremental cost per patients [year of value] | Incremental cost per patients (standardized to 2011 Euro) | CE with interventions | |
---|---|---|---|---|---|---|---|---|
Effects | Costs | |||||||
(%) | (%) | |||||||
ACEIs
| ||||||||
Golan et al. 1999 US [33] | 3 | 3 | Societal | The cost of ESRD (dialysis & transplant), ACEIs and screening | 15.63 years/11.82 QALYs with ‘treat all’, | ‘Treat all’ vs ‘screen for MiA’: $300a
| ‘Treat all’ vs ‘screen for MiA’: €299 | Very cost-effective [‘Treat all’ vs. ‘screen for MiA’: €8,062/QALY] |
15.59 years/11.78 QALYs with ‘screen for MiA’, 15.39 years/11.59 QALYs with ‘screen for gross proteinuria’ | ||||||||
Sakthong et al. 2001 Thailand [34] | 8 | 8 | Not mentioned | The cost of ESRD (haemodialysis) and ACEI | 9.04 years with enalapril, 7.54 years with control | -$1,198 [1999] | -€1,269 | Cost saving [Enalapril] |
Rosen et al. 2005 US [35] | 3 | 3 | Medicare and societal | (1) Medicare perspective: direct medical costs and future health care costs. | 10.55 years/8.36 QALYs with Medicare first-dollar coverage of ACEIs, 10.30 years /8.13 QALYs with at the time practice | -$1,606 [2003] | -€1,453 | Cost saving [Medicare first-dollar coverage of ACEIs] |
(2) Societal perspective: additional analyses included productivity gains and losses, caregiver time costs | ||||||||
Campbell et al. 2007 US [36] | 3 | 3 | Health payer | Direct medical costs of nephropathy, CVD, and ACEIs | -$772 for normoalbuminuria on diagnosis, -$7,098 for MiA on diagnosis, $7,987 for MaA on diagnosis [2005] | -€658 for normoalbuminuria on diagnosis, -€6,048 for MiA on diagnosis, €6,806 for MaA on diagnosis | Cost-neutral [ACEIs used on normoalbuminuria] | |
Cost saving [ACEIs on MiA] | ||||||||
Adarkwah et al. 2010 Germany [37] | 3 | 3 | the German statutory health insurance | The cost of ESRD (dialysis & transplant), ACEIs, ARBs and screening | 15.21 QALYs with ‘treat all’, | ‘Treat all’ vs. ‘placebo’: -€16,024 [2006] | ‘Treat all’ vs. ‘placebo’: -€16,841 | Cost saving [Treat all using ACEIs] |
15.14 QALYs with ‘screen for MiA’, 14.83 QALYs with ‘screen for MaA’, 14.46 QALYs with ‘placebo’ | ||||||||
Adarkwah et al. 2011 Netherlands [38] | 1.5 | 4 | Health care | The cost of ESRD (dialysis & transplant), ACEIs, ARBs and screening | 19.63 QALYs with ‘treat all’, 19.54 QALYs with ‘screen for MiA’, 19.15 with ‘screen for MaA’ | ‘Treat all’ vs. ‘screen for MiA’: -€2,719, ‘treat all’ vs. ‘screen for MaA’: -€12,356 [2010] | ‘Treat all’ vs. ‘screen for MiA’: -€2,749, ‘treat all’ vs. ‘screen for MaA’: -€12,492 | Cost saving [Treat all using ACEIs] |
ARBs
| ||||||||
Losartan
| ||||||||
Herman WH et al., 2003 US [39] | none | 3 | Health care system | The cost of ESRD (hemodialysis) and losartan therapy | Over 3.5 years: -$3,522 [2001] | Over 3.5 years: -€3,306 | Cost saving [losartan] | |
Souchet T et al., 2003 France [40] | none | 8.1%b
| French health care system | The cost of ESRD (dialysis) and losartan therapy | Over 3.5 years: -€3,863 [2002] | Over 3.5 years: -€4,522 | Cost saving [losartan] | |
Burgess ED et al., 2004 Canada [41] | none | none | Health care system | The cost of ESRD (dialysis & transplant) and losartan therapy | Over 3.5 years: -$3,675a
| Over 3.5 years: -€3,368 | Cost saving [losartan] | |
Szucs TD et al., 2004 Switzerland [42] | none | none | Swiss health care payer | The cost of ESRD (dialysis & transplant) and losartan therapy (only the insurance-paid part) | Over 3.5 years: -CHF4,084a
| Over 3.5 years: -€3,660 | Cost saving [losartan] | |
Seng WK et al., 2005 Hong Kong [32] (only data of Hong Kong were included) | 3 | 3 | Health care system | The cost of ESRD (dialysis) and losartan therapy | -$515 [2004] | -€413 | Cost-neutral [losartan] | |
Arredondo A et al., 2005 Mexico [43] | 3 | 3 | Health care system | The cost of ESRD (dialysis), diabetes and losartan therapy | 0.697 life years gained for losartan | -M$24,073 [2004] | -€1,861 | Cost saving [losartan] |
Vora J et al., 2005 UK [44] | 3.5 | 3.5 | The UK National Health Service (NHS) | The cost of ESRD (dialysis) and losartan therapy | 7.82 life years with losartan, 7.38 life years with placebo (0.44 life years gained for losartan) | -£6,622 [2004] | -€9,182 | Cost saving [losartan] |
Carides GW et al., 2006 US [45] | 3 | 3 | Health care system | The cost of ESRD (dialysis), diabetes and losartan therapy | 0.697 life years gained for losartan | -$24,632 [2002] | -€22,757 | Cost saving [losartan] |
Stafylas PC et al., 2007 Greece [46] | 3 | 3 | The Greek social insurance system | The cost of ESRD (dialysis & transplant) and 75% of drug treatment costs | Over 3.5 years: -€1,665.43 [2003] | Over 3.5 years: -€2,079 | Cost saving [losartan] | |
de Portu S et al., 2011 Italy [47] | 3 | 3 | National Health care Service | The cost of ESRD (hemodialysis) and losartan therapy | -€3,602.98 [2009] | -€3,664 | Cost saving [losartan] | |
de Portu S et al., 2011 France [47] | 3 | 3 | Health Insurance | The cost of ESRD (hemodialysis) and losartan therapy | -€4,531.35 [2009] | -€4,641 | Cost saving [losartan] | |
de Portu S et al., 2011 Germany [47] | 3 | 3 | Health Insurance | The cost of ESRD (hemodialysis) and losartan therapy | -€3,019.66 [2009] | -€3,062 | Cost saving [losartan] | |
de Portu S et al., 2011 Switzerland [47] | 3 | 3 | Medical Insurance | The cost of ESRD (hemodialysis) and losartan therapy | -€3,949.50 [2009] | -€3,977 | Cost saving [losartan] | |
de Portu S et al., 2011 US [47] | 3 | 3 | Centers for Medicare & Medicaid Services | The cost of ESRD (hemodialysis) and losartan therapy | -€3,855.50 [2009] | -€4,007 | Cost saving [losartan] | |
Irbesartan
| ||||||||
Rodby RA et al., 2003 US [48] | 3 | 3 | Health care system | The cost of ESRD (dialysis & transplant), hospitalizations, irbesartan & concomitant antihypertensive drugs | 8.225 years with irbesartan, 7.484 years with control (0.741 years gained for irbesartan) | -$15,607 [2000] | -€14,987 | Cost saving [irbesartan] |
Palmer AJ et al., 2003 Belgium [49] | 3 | 3 | Institut National d’Assurance de Maladie et Invalidite’ (INAMI) | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 8.57 years with irbesartan, 7.95 years with control (0.62 years gained for irbesartan) | -€11,885 [2002] | -€14,231 | Cost saving [irbesartan] |
Palmer AJ et al., 2003 France [49] | 3 | 3 | Social security | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 8.58 years with irbesartan, 7.97 years with control (0.61 years gained for irbesartan) | -€16,345 [2002] | -€19,132 | Cost saving [irbesartan] |
Coyle D et al., 2004 Canada [50] | 5 | 5 | Third party payer | The cost of ESRD (dialysis & transplant), irbesartan & concomitant antihypertensive drugs and other medical costs | 6.80 years with irbesartan, 6.37 years with control (0.43 years gained for irbesartan) | -CAD12,564 [2001] | -€11,457 | Cost saving [irbesartan] |
Palmer AJ et al., 2004 UK [51] | 1.5 | 6 | National Health Service (NHS) payer | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 0.58 years gained for irbesartan vs control | -£4,978a
| -€7,075 | Cost saving [irbesartan] |
Palmer AJ et al., 2004 US [52] | 3 | 3 | Third party reimbursement | The cost of ESRD (dialysis & transplant) and irbesartan | 11.46 years with ‘early irbesartan’, 10.54 years with ‘late irbesartan’, 10.50 years with control (0.96 years gained for irbesartan vs control) | Early irbesartan vs. control: -$11,922, late irbesartan vs. control: -$3,252 [2000] | Early irbesartan vs. control: -€11,448, late irbesartan vs. control: -€3,123 | Cost saving [early irbesartan] |
Palmer AJ et al., 2005 Spain [53] | 3 | 3 | Third party payer | The cost of ESRD (dialysis & transplant) and irbesartan | 12.37 years with ‘early irbesartan’, 11.53 years with control (0.84 years gained for irbesartan) | -€11,082a
| -€12,971 | Cost saving [early irbesartan] |
Palmer AJ et al., 2006 Switzerland [54] | 5 | 5 | Third party Swiss health insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 10.37 years with ‘early irbesartan’, 9.80 years with control (0.57 years gained for irbesartan) | -CHF21,487 [2003] | -€19,257 | Cost saving [early irbesartan] |
Palmer AJ et al., 2006 France [55] | 3 | 3 | Third party French social security insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 12.17 years /10.55 QALYs with ‘early irbesartan’, 11.27 years /9.58 QALYs with ‘late irbesartan’, 11.23 years /9.52 QALYs with control (0.94 years /1.03 QALYs gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -€22,314, ‘late irbesartan vs. control’: -€6,619 [2002] | ‘Early irbesartan’ vs. control: -€26,119, ‘late irbesartan’ vs. control: -€7,748 | Cost saving [early irbesartan] |
Palmer AJ et al., 2007 Hungary [56] | 5 | 5 | Third-party Hungarian health insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 8.16 years with ‘early irbesartan’, 7.62 years with control (0.54 years gained for irbesartan) | -HUF519,993 [2002] | -€2,564 | Cost saving [early irbesartan] |
Palmer AJ, 2007 UK [57] | 3.5 | 3.5 | Third party UK National Health Service (NHS) payer | The cost of ESRD (dialysis & transplant) and irbesartan | 11.00 years with ‘early irbesartan’, 10.20 years with ‘late irbesartan’, 10.18 years with control (0.82 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -£3,801, ‘late irbesartan’ vs. control:- £1,491 [2002] | ‘Early irbesartan’ vs. control: -€5,532, ‘late irbesartan’ vs. control: -€2,170 | Cost saving [early irbesartan] |
Coyle D et al., 2007 Canada [58] | 5 | 5 | Canadian health and social care system | All direct costs, including the costs of health, social services, long-term care. | 11.52 years with ‘early irbesartan’, 11.06 years with ‘late irbesartan’, 10.90 years with control (0.62 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -CAD68,400, ‘late irbesartan’ vs. control: -CAD14,300 [2006] | ‘Early irbesartan’ vs. control: -€57,871, ‘late irbesartan’ vs. control: -€12,099 | Cost saving [early irbesartan] |
Yang W.C. et al., 2007 Taiwan [59] | 3 | 3 | Third-party payer in Taiwan (Taiwan National Health Insurance Program) | The cost of ESRD (dialysis & transplant) and irbesartan | 12.003 years with ‘early irbesartan’, 11.332 years with ‘late irbesartan’, 11.223 years with control (0.780 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -$7,603, ‘late irbesartan’ vs. control: -$3,233 [2004] | Cost saving [early irbesartan] | |
Annemans L et al., 2008 China, Taiwan, Malaysia, Thailand, South Korea [60] | 5 | 5 | Third party payer | The cost of ESRD (dialysis & transplant) and irbesartan | ‘Early irbesartan’ strategy had the longest life expectancy (no detail data) | The least expensive strategy: ‘early irbesartan’ (no detail data) | Cost saving [early irbesartan] | |
Valsartan
| ||||||||
Smith DG et al., 2004 US [61] | 3 | 3 | Third-party payer | Medical care costs including costs of study drugs, routine health care services, and aggregate estimates of medical care associated with the various health states. | 6.390 QALYs with valsartan, 5.835 QALYs with amlodipine (0.555 QALYs gained for valsartan) | -$32,412 [2001] | -€30,424 | Cost saving [valsartan] |