Modelling and costing the consequences of using an ACE inhibitor to slow the progression of renal failure in type I diabetic patients

Bruce Hendry, G C Viberti, S Hummel, A Bagust, J Piercy

    Research output: Contribution to journalArticlepeer-review

    27 Citations (Scopus)

    Abstract

    Antihypertensive drugs slow the progressive decline in renal function seen in patients with insulin-dependent diabetes and nephropathy. In a recent study, the ACE inhibitor captopril protected against this deterioration in renal function. We developed an economic model to analyse the cost impact of ACE inhibitor treatment on progression to endstage renal failure (ESRF) in diabetic patients over 4 years. Two scenarios were compared: one describing the progression of a cohort of 1000 patients receiving 25 mg captopril three times daily, and the other for an equivalent cohort without such prophylactic treatment. Previously published data were used to estimate the transition rates for each stage from the onset of renal failure until death. All direct costs were discounted by an annual rate of 6%, and were subjected to sensitivity analysis. The discounted cost saving of ACE inhibitor treatment for a cohort of 1000 patients was estimated as 0.95 million pounds over 4 years. Under sensitivity analysis, these results were very robust to variations in the costs of ESRF treatment. Prophylactic treatment with ACE inhibitors was predicted to provide substantial increases in life expectancy and reduction in the incidence of ESRF, while also providing significant economic savings.
    Original languageEnglish
    Pages (from-to)277-82
    Number of pages6
    JournalQJM
    Volume90
    Issue number4
    DOIs
    Publication statusPublished - Apr 1997

    Keywords

    • Adolescent
    • Adult
    • Aged
    • Angiotensin-Converting Enzyme Inhibitors
    • Captopril
    • Cohort Studies
    • Diabetes Mellitus, Type 1
    • Diabetic Nephropathies
    • Disease Progression
    • England
    • Health Care Costs
    • Humans
    • Kidney Failure, Chronic
    • Middle Aged
    • Models, Econometric
    • Sensitivity and Specificity

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