Einsparpotentiale in der Therapie hypertoner Typ-2-Diabetiker aufgrund verzögerter terminaler Niereninsuffizienz

  • Klaus-Peter Ratzmann
  • Olaf Pirk
  • Jan Carels
  • Peter Bramlage
  • Wilhelm Kirch
Original-Forschungsarbeit

Cost-saving potentials in the therapy of hypertonic type 2 diabetics due to delayed end-stage renal disease

Abstract

Objective

Type 2 diabetes is a major health problem. 30 % of all patients being on dialysis suffer from end-stage renal disease (ESRD) due to diabetes. This is very costly. The angiotensin II receptor blocker (ARB) irbesartan has proven its capability to prevent or delay ESRD. Based on the results of the multicentre double-blind, randomized, placebo-controlled Irbesartan Diabetic Nephropathy Trial (IDNT), this study aims to show that a treatment of renal diseases in hypertensive type 2 diabetics with the ARB irbesartan is cost-saving for the German health care system. Results are compared to findings in the RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) trial of losartan.

Study design and methods

A cost-effectiveness analysis from the German payers’ perspective was conducted taking direct costs into account. The year of costing was 2004. Drug prices were calculated by subtracting manufacturer and pharmacist rebates as well as patients’ co-payments. Additional treatment costs induced by ARB therapy with irbesartan and losartan were contrasted with the therapy effects as shown by the avoided events. Public sources were used for cost data and for information on dialysis and transplantation in diabetics with ESRD.

Patient groups

1,715 type 2 diabetics with hypertension and limited renal function were included in IDNT (2.6 years, subgroup with 300 mg/d irbesartan) and 1,513 in RENAAL (3.5 years, subgroup with up to 100 mg/d losartan). The patient number needed to treat (NNT) to prevent one ESRD in a patient of the respective target group was the efficacy parameter for this cost-effectiveness analysis.

Results

The NNT for the primary endpoint ESRD was 28 during the study period of 2.6 years in IDNT and 17 during 3.4 years in RENAAL. That means additional treatment costs of € 25,007 and € 29,565, respectively, lead to one prevented ESRD. The prevented ESRD (82 % dialysis, 18 % transplantation) is worth € 45,766. This shows a benefit of € 20,758 after 2.6 years or € 7,984 per year for irbesartan treatment and of € 16,200 after 3.4 years or € 4,765 per year for losartan, follow-up treatment costs not included. Based on epidemiologic data, our results suggest savings of 3.2 billion € after 2.6 years for the German health care system if an additional 681 million € were invested annually in the treatment of type 2 diabetics with irbesartan.

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Copyright information

© Adis International Limited 2004

Authors and Affiliations

  • Klaus-Peter Ratzmann
    • 1
  • Olaf Pirk
    • 2
  • Jan Carels
    • 3
  • Peter Bramlage
    • 4
  • Wilhelm Kirch
    • 4
  1. 1.Diabetologische SchwerpunktpraxisBerlinDeutschland
  2. 2.Fricke & Pirk GmbHNürnbergDeutschland
  3. 3.BerlinDeutschland
  4. 4.Institut für Klinische PharmakologieMedizinische Fakultät Carl Gustav Carus der Technischen Universität DresdenDresdenDeutschland

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