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Cost-consequence analysis in a French setting of screening and optimal treatment of nephropathy in hypertensive patients with type 2 diabetes.
Cost-consequence analysis in a French setting of screening and optimal treatment of nephropathy in hypertensive patients with type 2 diabetes.
- Source :
-
Diabetes & metabolism [Diabetes Metab] 2006 Feb; Vol. 32 (1), pp. 69-76. - Publication Year :
- 2006
-
Abstract
- Aim: Forty percent of hypertensive type 2 diabetes patients develop nephropathy (microalbuminuria/overt nephropathy), indicating end organ damage, increased risk of cardiovascular disease (CVD), and death. In France, screening rates and nephropathy treatment are suboptimal. We assessed the health economic impact of nephropathy screening in hypertensive patients with type 2 diabetes followed by optimal antihypertensive/nephroprotective therapy in those who have nephropathy in France.<br />Methods: A Markov/Monte Carlo model simulated lifetime impacts of screening for albuminuria (microalbuminuria/overt nephropathy) using semi-quantitative urine dipsticks in a primary care setting, and subsequent addition of irbesartan 300 mg to conventional therapy in hypertensive type 2 diabetes patients identified as having nephropathy. Progression from no renal disease to end-stage renal disease (ESRD) was simulated. Probabilities, utilities and costs of CVD events, medications and ESRD treatment came from published sources. Cumulative incidence of ESRD, life expectancy, quality-adjusted life years (QALYs) and direct costs were projected. Second-order Monte Carlo simulation accounted for uncertainty in multiple parameters. Costs and QALYs were discounted at 3% annually.<br />Results: Screening and optimized treatment led to a 42% reduction in the cumulative incidence of ESRD from 10.1 +/- 9.9% without screening to 5.8 +/- 5.7%, improvements in life expectancy of 0.38 +/- 0.59 years, improvements of 0.29 +/- 0.32 QALYs, and decreased costs of Euro 4,812 +/- 7,882/patient over 25 years. Sensitivity analysis showed that the results were robust. Screening was most beneficial when performed in younger patients.<br />Conclusion: In hypertensive patients with type 2 diabetes, screening for albuminuria followed by optimal antihypertensive/nephroprotective treatment improves patient outcomes and leads to cost savings in France.
- Subjects :
- Adult
Aged
Aged, 80 and over
Computer Simulation
Cost of Illness
Diabetes Mellitus, Type 2 mortality
Diabetes Mellitus, Type 2 therapy
Diabetic Angiopathies mortality
Diabetic Angiopathies therapy
Diabetic Nephropathies mortality
Diabetic Nephropathies therapy
France
Humans
Hypertension mortality
Hypertension therapy
Incidence
Kidney Failure, Chronic economics
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic therapy
Markov Chains
Middle Aged
Monte Carlo Method
Probability
Diabetes Mellitus, Type 2 economics
Diabetic Angiopathies economics
Diabetic Nephropathies economics
Hypertension economics
Subjects
Details
- Language :
- English
- ISSN :
- 1262-3636
- Volume :
- 32
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Diabetes & metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 16523189
- Full Text :
- https://doi.org/10.1016/s1262-3636(07)70249-5