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

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  • Cornelis Boersma
  • Jarir Atthobari
  • Ron Gansevoort
  • Lolkje Jong-Van den Berg
  • Paul Jong
  • Dick Zeeuw
  • Lieven Annemans
  • Maarten Postma

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. Copyright Adis Data Information BV 2006

Suggested Citation

  • Cornelis Boersma & Jarir Atthobari & Ron Gansevoort & Lolkje Jong-Van den Berg & Paul Jong & Dick Zeeuw & Lieven Annemans & Maarten Postma, 2006. "Pharmacoeconomics of Angiotensin II Antagonists in Type 2 Diabetic Patients with Nephropathy," PharmacoEconomics, Springer, vol. 24(6), pages 523-535, June.
    • Handle: RePEc:spr:pharme:v:24:y:2006:i:6:p:523-535
    DOI: 10.2165/00019053-200624060-00001
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    References listed on IDEAS

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    1. van Os, Nicole & Niessen, Louis W. & Bilo, Henk J. G. & Casparie, Anton F. & van Hout, Ben A., 2000. "Diabetes nephropathy in the Netherlands: a cost effectiveness analysis of national clinical guidelines," Health Policy, Elsevier, vol. 51(3), pages 135-147, April.
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    1. Nurul-Ain Mohd-Tahir & Shu-Chuen Li, 2019. "Budget impact analysis of increasing prescription of renin-angiotensin system inhibitors drugs to standard anti-hypertensive treatments in patients with diabetes and hypertension in a hypothetical coh," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-13, February.

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