Advertisement

PharmacoEconomics

, Volume 24, Issue 6, pp 549–558 | Cite as

The Impact of Losartan on the Lifetime Incidence of End-Stage Renal Disease and Costs in Patients with Type 2 Diabetes and Nephropathy

  • George W. Carides
  • Shahnaz Shahinfar
  • Erik J. Dasbach
  • William F. Keane
  • William C. Gerth
  • Charles M. Alexander
  • William H. Herman
  • Barry M. Brenner
Original Research Article

Abstract

Introduction: The RENAAL (Reduction of Endpoints in Non-insulin dependent diabetes with the Angiotensin II Antagonist Losartan) study demonstrated that, in hypertensive patients with type 2 diabetes mellitus and nephropathy, treatment with losartan plus conventional antihypertensive therapy (CT) reduced the relative risk of end-stage renal disease (ESRD) by 29% versus placebo over the time span of the study (mean patient follow-up of 3.4 years). The objective of this study was to project the effect of losartan compared with placebo on the lifetime incidence of ESRD and associated costs (from a US healthcare system perspective).

Methods: To estimate lifetime incidence of ESRD, we used a competing risks method to account for the risk of death without ESRD. We estimated the cost ($US, year 2002 values) associated with ESRD by combining the cumulative incidence of ESRD with the lifetime cost associated with ESRD. Total cost was estimated as the sum of the cost associated with ESRD, the cost of losartan study therapy and other costs (non-ESRD/non-losartan) expected for patients with type 2 diabetes. Survival was estimated by weighting the life expectancies with and without ESRD by the cumulative risk of ESRD. Costs and outcomes were discounted by 3% per annum.

Results: We projected a lower lifetime incidence of ESRD for losartan patients (66%) compared with placebo patients (83%). This reduction in ESRD resulted in a decrease in cost associated with ESRD of $US31 803 per patient and a gain of 0.99 life-years per patient (0.70 discounted). After accounting for the cost of losartan and the additional cost associated with greater survival, we projected that treatment with losartan would result in a lifetime net saving of $US24 632 per patient.

Conclusion: Treatment with losartan plus CT in patients with type 2 diabetes and nephropathy reduced the within-trial incidence of ESRD and is projected to result in lifetime reductions in ESRD and associated costs, and increased survival, versus placebo.

Keywords

Losartan Weibull Model Losartan Group ESRD Incidence Losartan Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This study was funded by a research grant from Merck & Co., Inc.

G.W. Carides, E.J. Dasbach, W.F. Keane, W.C. Gerth and C.M. Alexander are employed by, and own stock in, Merck & Co., Inc.

S. Shahinfar was formerly employed by, and currently owns stock in, Merck & Co., Inc.

W.H. Herman has consulted with and received lecture fees from Merck & Co., Inc.

B.M. Brenner has received a research grant and consultancy fees from Merck & Co., Inc.

All authors made substantial contributions to the intellectual content of the paper.

References

  1. 1.
    Sandoz MS, Ess SM, Keusch GW, et al. Prevalence and direct medical costs of end-stage renal disease in patients with type 2 diabetes mellitus in Switzerland for 2001. Swiss Med Wkly 2004 Aug 7; 134 (31–32): 448–458PubMedGoogle Scholar
  2. 2.
    US Renal Data System. USRDS 2002 annual data report: atlas of end-stage renal disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002Google Scholar
  3. 3.
    Van Dijk PC, Jager KJ, Stengel B, et al. Renal replacement therapy for diabetic end-stage renal disease: data from 10 registries in Europe (1991–2000). Kidney Int 2005 Apr; 67 (4): 1489–1499CrossRefGoogle Scholar
  4. 4.
    Bommer J. Prevalence and socio-economic aspects of chronic kidney disease. Nephrol Dial Transplant 2002; 17 Suppl. 11: 8–12PubMedCrossRefGoogle Scholar
  5. 5.
    US Renal Data System. USRDS 2000 annual data report. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2000 Jun: 251Google Scholar
  6. 6.
    Gordios A, Scuffham P, Shearer A, et al. The health care costs of diabetic nephropathy in the United States and the United Kingdom. J Diabetes Complications 2004 Jan–Feb; 18 (1): 18–26CrossRefGoogle Scholar
  7. 7.
    Brenner BM, Cooper ME, De Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–869PubMedCrossRefGoogle Scholar
  8. 8.
    American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25: S33–S49CrossRefGoogle Scholar
  9. 9.
    Herman WH, Shahinfar S, Carides GW, et al. Losartan reduces the costs associated with diabetic end-stage renal disease. Diabetes Care 2003; 26 (3): 683–687PubMedCrossRefGoogle Scholar
  10. 10.
    Lin DY. Non-parametric inference for cumulative incidence functions in competing risks studies. Stat Med 1997 Apr 30; 16 (8), 901–910PubMedCrossRefGoogle Scholar
  11. 11.
    Lawless JF. Statistical models and methods for lifetime data. New York: Wiley, 1982Google Scholar
  12. 12.
    Akaike H. Information theory and an extension of the maximum likelihood principle. In: Petrov EBN, Csaki F, editors. 2nd International Symposium of Information Theory and Control. Budapest: Akademia Kiado, 1973: 267–281Google Scholar
  13. 13.
    Wolfe RA, Hirth RA, Port FK, et al. Mortality and costs in the first year of dialysis: a comparison between hemodialysis (HD) and peritoneal dialysis (PD) [abstract]. J Am Soc Nephrol 1998; 9: 241AGoogle Scholar
  14. 14.
    Manninen DL, Dong FE, Dasbach EJ, et al. The longitudinal cost of end-stage renal disease in persons with diabetes in the United States. J Med Econ 2004; 7: 41–51CrossRefGoogle Scholar
  15. 15.
    Firon B, Tibshirani RJ. An introduction to the bootstrap. New York: Chapman and Hall, 1993Google Scholar
  16. 16.
    Gerth WC, Remuzzi G, 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 Dec; 62 Suppl. 82: 68–72CrossRefGoogle Scholar
  17. 17.
    Rodby RA, et al. The cost effectiveness of irbesartan in the treatment of hypertensive patients with type 2 diabetic nephropathy. Clin Ther 2003 Jul; 25 (7): 2102–2119PubMedCrossRefGoogle Scholar
  18. 18.
    US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and irqxoving health and objectives for improving health. 2 vols. Washington, DC: US Government Printing Office, 2000 NovGoogle Scholar
  19. 19.
    NHANES III Third National Health and Nutrition Examination Survey, 1988–1994. Hyattsville (MD): National Center for Health Statistics [online]. Available from URL: http://www.cdc.gov/nchs/products/elec_prods/subject/nhanes3.htm [Accessed 2006 Feb]Google Scholar
  20. 20.
    Joyce AT, Iacoviello JM, Nag S, et al. End-stage renal disease-associated managed care costs among patients with and without diabetes. Diabetes Care 2005; 27: 2829–2835CrossRefGoogle Scholar
  21. 21.
    Murray L, editor. Physician’s desk reference. 60th ed. Montvale (NJ): Thomson PDR, 2006: 1916Google Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • George W. Carides
    • 1
  • Shahnaz Shahinfar
    • 1
  • Erik J. Dasbach
    • 1
  • William F. Keane
    • 1
  • William C. Gerth
    • 1
  • Charles M. Alexander
    • 1
  • William H. Herman
    • 2
  • Barry M. Brenner
    • 3
  1. 1.Merck Research Laboratories, Merck & Co Inc.Blue BellUSA
  2. 2.Departments of Internal Medicine and EpidemiologyUniversity of Michigan Health SystemAnn ArborUSA
  3. 3.Renal DivisionBrigham and Women’s HospitalBostonUSA

Personalised recommendations