Diabetologie und Stoffwechsel 2011; 6 - P282
DOI: 10.1055/s-0031-1280949

Cost-effectiveness of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers in newly diagnosed type 2 diabetes in Germany

CC Adarkwah 1, 2, 3, A Gandjour 2, 4, 5
  • 1RWTH Universitätsklinikum Aachen, Medizinische Klinik III, Aachen, Germany
  • 2Institut für Gesundheitsökonomie und klinische Epidemiologie, Universität zu Köln, Köln, Germany
  • 3Maastricht University, Faculty of Health, Medicine and Life Science, Maastricht, Netherlands
  • 4Lousiana State University, Pennington Biomedical Research Center, Baton Rouge, United States
  • 5Rice University, The James A. Baker III Institute for Public Policy, Houston, United States Minor Outlying Islands

Objective: Type 2 diabetes is the main cause of end-stage renal disease (ESRD) in Europe and the USA. Angiotensin-converting enzyme (ACE) inhibitors slow down the progression of renal disease and therefore provide a renal-protective effect. However, uncertainty exists concerning the best time to start with ACE-inhibitor therapy. Furthermore, about 10% of patients develop ACE-inhibitor induced cough and thus are eligible for more expensive angiotensin II receptor blockers (ARBs). The aim was to assess the most cost-effective time to start an ACE inhibitor (or ARB therapy in the event of cough) in patients with type 2 diabetes in Germany.

Methods: Three strategies were compared: treating all patients at the time of diagnosing diabetes, screening for microalbuminuria, and screening for macroalbuminuria. A lifetime Markov decision model with simulated 50-year-old patients with newly diagnosed type 2 diabetes mellitus was developed using published data on costs and health outcomes and simulating the progression of renal disease with costs and benefits discounted at 3%. A statutory health insurance perspective was adopted. Quality-adjusted life expectancy, lifetime costs, and cost-effectiveness were the main outcomes.

Results: In the base-case analysis, the treat-all strategy is associated with the lowest costs and highest benefit and therefore dominates screening both for macroalbuminuria and microalbuminuria. A multivariate sensitivity analysis shows that the probability of savings is 89%.

Conclusions: Patients with type 2 diabetes should receive an ACE inhibitor immediately after diagnosis if they do not have any contraindications. The potential for cost savings (ie, reductions in health care expenditures) would be even larger if the prevention of cardiovascular events were considered.