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01.06.2006 | Leading Article

Pharmacoeconomics of Angiotensin II Antagonists in Type 2 Diabetic Patients with Nephropathy

Implications for Decision Making

verfasst von: Cornelis Boersma, Jarir Atthobari, Ron T. Gansevoort, Lolkje T. W. de Jong-Van den Berg, Paul E. de Jong, Dick de Zeeuw, Lieven J. P. Annemans, Maarten J. Postma

Erschienen in: PharmacoEconomics | Ausgabe 6/2006

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Abstract

Angiotensin II receptor antagonists (angiotensin II receptor blockers; ARBs) are a class of antihypertensive drugs that are generally considered comparable to ACE inhibitors in the prevention of heart and kidney failure. However, these two classes of agents do interfere in different stages of the renin-angiotensin system. In patients with type 2 diabetes mellitus, advantages for ARBs over conventional (non-ACE inhibitor) therapy on progression from micro- to macroalbuminuria and overt nephropathy and end-stage renal disease have been shown in clinical trials. In patients with type 2 diabetes and end-stage renal disease, the need for dialysis and/or transplantation results in the use of major healthcare resources. This paper reviews the available economic evidence on treatment with ARBs in type 2 diabetic patients with advanced renal disease.

Within-trial analytic and Markov model economic evaluations of the RENAAL (Reduction of Endpoint in Non-insulin dependent diabetes mellitus with Angiotensin II Antagonist Losartan), IDNT (Irbesartan Diabetic Nephropathy Trial) and IRMA (IRbesartan in type 2 diabetes with MicroAlbuminuria)-2 studies suggest that treatment with ARBs in patients with type 2 diabetes with overt or incipient nephropathy confers health gains and net cost savings compared with conventional (non-ACE inhibitor) therapy. For reimbursement and reference pricing decisions, there is a need for a head-to-head comparison of an ACE inhibitor with ARBs to model all possible costs and effects of ACE inhibitors and ARBs. This will result in a proper pharmacoeconomic outcome, where both types of drugs can be compared for healthcare decisions.

Laverman GD, Remuzzi G, Ruggenenti P. ACE inhibition versus angiotensin receptor blockade: which is better for renal and cardiovascular protection? J Am Soc Nephrol 2004; 15: S64–S70PubMedCrossRef

Postma MJ, Kruidhof H, de Jong-van den Berg LT, et al. Pharmacoeconomic aspects of losartan treatment to delay progression of renal disease in patients with type 2 diabetes. Expert Opin Pharmacother 2003; 4 (9): 1543–1550PubMedCrossRef

Coyle JD, Gardner SF, White CM. The renal protective effects of angiotensin II receptor blockers in type 2 diabetes mellitus. Ann Pharmacother 2004; 38: 1731–1738PubMedCrossRef

Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losaftan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. NEngl JMed 2001; 345 (12): 861–869CrossRef

Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345 (12): 851–860PubMedCrossRef

Parving HH, Lehnert H, Bröchner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345 (12): 870–878PubMedCrossRef

American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2005; 28 Suppl. 1: S4–S36CrossRef

Rippin HH, Barnett AH, Bain SC. Cost-effective strategies in the prevention of diabetic nephropathy. Pharmacoeconomics 2004; 22 (1): 9–28PubMedCrossRef

van Hout B, Simeon GP, McDonnell J, et al. Economic evaluation of benazepril in chronic renal insufficiency. Kidney Int 1997; 52 (63): S159–S162

10.

van Ballegooie E, van Everdingen JJE. CBO guidelines on diagnosis, treatment, and prevention of complication in diabetes mellitus, retinopathy, foot ulcers, nephropathy and cardiovascular diseases: Dutch Institute for Quality Assurance [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 2000; 144 (9), 413–418PubMed

11.

van Os N, Niessen LW, Bilo HJ, et al. Diabetes nephropathy in the Netherlands: a cost-effectiveness analysis of national clinical guidelines. Health Policy 2000; 51: 135–147PubMedCrossRef

12.

Palmer AJ, Annemans L, Roze S, et al. An economic evaluation of irbesartan in the treatment of patients with type 2 diabetes, hypertension and nephropathy: cost-effectiveness of Irbesartan in Diabetic Nephropathy Trial (IDNT) in the Belgian and French settings. Nephrol Dial Transplant 2003; 18: 2059–2066PubMedCrossRef

13.

USRDS annual data report 2004. Bethesda (MD): National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, 2004

14.

Hillege HL, Fidler V, Diercks GFH, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002; 106: 1777–1782PubMedCrossRef

15.

Diercks GFH, Hillege HL, van Boven AI, et al. Microalbuminuria modifies the mortality risk associated with electrocardiographic ST-T segment changes. J Am Coll Cardiol 2002; 40 (8): 1401–1407PubMedCrossRef

16.

Asselbergs FW, Hillege HL, van Gilst WH. Framingham score and microalbuminuria: combined future targets for primary prevention? Kidney Int 2004; 66 Suppl. 92: 5111–5114CrossRef

17.

Ruilope LM, Segura J. Losartan and other angiotensin II antagonists for nephropathy in type 2 diabetes mellitus: a review of the clinical trial evidence. Clin Ther 2003; 25 (12): 3044–3064PubMedCrossRef

18.

Zanella MT, Ribiero AB. The role of angiotensin II antagonism in type 2 diabetes mellitus: a review of renoprotection studies. Clin Ther 2002; 24 (7): 1019–1034PubMedCrossRef

19.

Herman WH, Shahinfar S, Carides GW, et al. Losartan reduces the costs associated with diabetic end-stage renal disease: the RENAAL study economic evaluation. Diabetes Care 2003; 26: 683–687PubMedCrossRef

20.

Rodby RA, Chiou CF, Borenstein J, et al. The cost-effectiveness of irbesartan in the treatment of hypertensive type 2 diabetic nephropathy. Clin Ther 2003; 25 (7): 2102–2119PubMedCrossRef

21.

Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995–1003PubMedCrossRef

22.

Gerstein HC, Yusuf S, Mann JFE, et al. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICROHOPE substudy. Lancet 2000; 355: 253–259CrossRef

23.

Yusuf S, Sleight P, Dagenais G, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342 (3): 145–153PubMedCrossRef

24.

de Zeeuw D, Remuzzi G, Parving HR, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 2004; 110: 921–927PubMedCrossRef

25.

de Zeeuw D, Remuzzi G, Parving HR, et al. Proteinuria, a target for renoprotectionin patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int 2004; 65: 2309–2320PubMedCrossRef

26.

Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329 (20): 1456–1462PubMedCrossRef

27.

Huston P, Peterson R. Withholding proven treatment in clinical research. N Engl J Med 2001; 345: 912–914PubMedCrossRef

28.

Data on file, Merck & Co., Inc. 2003

29.

Easthope SE, Jarvis B. Candesartan cilexetil: an update of its use in essential hypertension. Drugs 2002; 62 (8): 1253–1287PubMedCrossRef

30.

Warner GT, Jarvis B. Olmesartan medoxomil. Drugs 2002; 62 (8), 1345–1353PubMedCrossRef

31.

Ruilope L, Jager B. Eprosartan for the treatment of hypertension. Expert Opin Pharmacother 2003; 4: 107–114PubMedCrossRef

32.

Viberti G, Wheeldon NM. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: the MicroAlbuminuria Reduction With V ALsartan (MARVAL) study investigators. Circulation 2002; 106: 672–678PubMedCrossRef

33.

Lindholm LH, Ibsen H, Dahlöf B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention for Endpoint reduction hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 1004–1010PubMedCrossRef

34.

Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicenter trial (the EUROPA study). The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease investigators. Lancet 2003; 362: 782–788PubMedCrossRef

35.

Gerstein HC, Mann JFE, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421–426PubMedCrossRef

36.

Ruggenenti P, Fassi A, Ilieva AP, et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351 (19): 1941–1951PubMedCrossRef

37.

Gomma AH, Fox KM. The EUROPA trial: design, baseline demography and status of the substudies. The EUROPA investigators. Cardiovasc Drugs Ther 2001; 15: 169–179PubMedCrossRef

38.

Ferrari R, Arbustini E, Blann A, et al. PERTINENT (PER-indopril-Thrombosis, InflammatioN, Endothelial dysfunction and Neurohormonal activation Trial): a sub-study of the EUROPA Study. Cardiovasc Drugs Ther 2003; 17: 83–91CrossRef

39.

Briggs AH, O’Brien BJ, Blackbouse G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Annu Rev Public Health 2002; 23: 377–401PubMedCrossRef

40.

Briggs A, Sculpher M. An introduction to markov modelling for economic evaluation. Pharmacoeconomics 1998; 13 (4): 397–409PubMedCrossRef

41.

International Society for Pharmacoeconomics & Outcomes Research (ISPOR). Pharmacoeconomic guidelines around the world [online]. Available from URL: http://www.ispor.org/PEguidelines/index.asp [Accessed 2005 Jun 30]

42.

Adler AI, Stevens RJ, Manley SE, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225–232PubMedCrossRef

43.

Postma MJ, Bartstra J, Annemans LJP. Angiotensin-II antagonists in diabetes mellitus type 2 [in Dutch]. Pharm Weekbl 2004; 139 (33): 1060–1063

44.

Palmer AJ, Annemans L, Roze S, et al. Health economic consequences of the use of irbesartan in patients in Germany with type 2 diabetes, nephropathy and hypertension [in German]. Dtsch Med Wochenschr 2004; 129: 13–18PubMedCrossRef

45.

Palmer AJ, Annemans L, Roze S, et al. An economic evaluation of the Irbesartan in Diabetic Nephropathy Trial (IDNT) in a UK setting. J Hum Hypertens 2004; 18 (10): 733–738PubMedCrossRef

46.

Palmer AJ, Annemans L, Roze S, et al. Cost-effectiveness of early irbesartan treatment versus control (standard antihypertensive medications excluding ACE inhibitors, other angiotensin-2 receptor antagonists, and dihydropyridine calcium channel blockers) or late irbesartan treatment in patients with type 2 diabetes, hypertension, and renal disease. Diabetes Care 2004; 27: 1897–1903PubMedCrossRef

47.

Palmer AJ, Annemans L, Roze S, et al. Irbesartan is projected to be cost and life saving in a Spanish setting for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria. Kidney Int 2005; 67 Suppl. 93: S52–S54CrossRef

48.

Gold MR, Siegel JE, Russel LB, et al., editors. Cost-effectiveness in health and medicine. New York: University Press, 1996

49.

Alexander CM, Lyle PA, Keane WF, et al. Losartan and the United States costs of end-stage renal disease by baseline albuminuria in patients with type 2 diabetes and nephropathy. Kidney Int 2004; 66 Suppl. 92: S115–S117CrossRef

50.

Gerth WC, RemuzziG, Viberti G, et al. Losartan reduces the burden and cost of ESRD: public health implications from the RENAAL study for the European Union. Kidney Int 2002; 62 (82): S68–S72CrossRef

51.

College voor zorgverzekeringen (CVZ). Guidelines for pharmacoeconomic research [in Dutch]. Amstelveen: College voor zorgverzekeringen, 1999

52.

Golan L, Birkmeyer JD, Welch HG. The cost-effectiveness of treating all patients with type 2 diabetes with angiotens-inconverting enzyme inhibitors. Ann Intern Med 1999; 131 (9): 660–667PubMed

53.

Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM: I. Model construction and assumptions. Diabetes Care 1997; 20 (5): 725–734PubMedCrossRef

54.

Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20 (5): 735–744PubMedCrossRef

55.

Palmer AJ, Roze S, Valentine WJ, et al. Irbesartan is projected to be cost and life saving compared to standard blood pressure control alone for treatment of patients with type 2 diabetes, hypertension, and microalbuminuria in Spanish, Swedish and Swiss settings [abstract]. Value Health 2004; 7 (6): 655CrossRef

56.

Barnett AH, Bain SC, Bouter P, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351 (91): 1952–1961PubMedCrossRef

57.

Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993; 118: 577–581PubMed

58.

Ravid M, Brosh D, Levi Z, et al. Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus: a randomized controlled trial. Ann Intern Med 1998; 128: 982–988PubMed

59.

Lindholm LH, Dahltif B, Edelman JM, et al. Effect of losartan on sudden cardiac death in people with diabetes: data from the LIFE study. Lancet 2003; 362: 619–620PubMedCrossRef

60.

Schädlich PK, Brecht JG, Rangoonwala B, et al. Cost-effectiveness of ramipril in patients at high risk for cardiovascular events: economic evaluation of the HOPE (Heart Outcomes Prevention Evaluation) study for Germany from the statutory health insurance perspective. Pharmacoeconomics 2004; 22 (15), 955–973PubMedCrossRef

61.

Björholt I, Andersson FL, Kahan T, et al. The cost-effectiveness of ramipril in the treatment of patients at high risk of cardiovascular events: a Swedish sub-study to the HOPE study. J Intern Med 2002; 251: 508–517PubMedCrossRef

62.

Strippoli GFM, Craig M, Deeks JJ, et al. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ 2004; 329: 828–831PubMedCrossRef

63.

Pylypchuk GB. ACE-inhibitor versus angiotensin II blocker induced cough and angioedema. Ann Pharmacother 1998; 32: 1060–1066PubMedCrossRef

64.

Fuchs SA, Meyboom RHB, van Puijenbroek EP, et al. Use of angiotensin receptor antagonists in patients with ACE-inhibitor induced angiodema. Pharm World Sci 2004; 26: 191–192PubMedCrossRef

65.

Mitch WE. Treating diabetic nephropathy: are there only economic issues? N Engl J Med 2004; 351 (19): 1934–1936PubMedCrossRef

66.

Palmer AJ, Rodby RA. Health economics studies assessing irbesartan use in patients with hypertension, type 2 diabetes, and microalbuminuria. Kidney Int 2004; 66 Suppl. 92: S118–S120CrossRef

67.

Atthobari J, Asselbergs FW, Boersma C, et al. Cost-effectiveness of screening for albuminuria and subsequent treatment with ACE-inhibitor to prevent cardiovascular events: a pharmacoeconomic analysis linked to the PREVEND and PREVEND-IT studies. The PREVEND-IT study group. Clin Ther 2006; 28 (3): 432–444PubMedCrossRef

68.

Johannesson M, Jönsson B, Kjekhus J, et al. Cost-effectiveness of simvastatin treatment in lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336: 332–336PubMedCrossRef

Titel: Pharmacoeconomics of Angiotensin II Antagonists in Type 2 Diabetic Patients with Nephropathy
Implications for Decision Making
verfasst von: Cornelis Boersma
Jarir Atthobari
Ron T. Gansevoort
Lolkje T. W. de Jong-Van den Berg
Paul E. de Jong
Dick de Zeeuw
Lieven J. P. Annemans
Maarten J. Postma
Publikationsdatum: 01.06.2006
Verlag: Springer International Publishing
Erschienen in: PharmacoEconomics / Ausgabe 6/2006
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200624060-00001

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Pharmacoeconomics of Angiotensin II Antagonists in Type 2 Diabetic Patients with Nephropathy

Implications for Decision Making

Abstract

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

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