Table 4 Main results of economic evaluations on ACEIs and ARBs
Study, country/ region | Discount rate (per annum) | Perspective | Cost categories | Discounted life expectancy/QALY | Incremental cost per patients [year of value] | Incremental cost per patients (standardized to 2011 Euro) | CE with interventions | |
|---|---|---|---|---|---|---|---|---|
Effects | Costs | |||||||
(%) | (%) | |||||||
ACEIs | Â | Â | Â | Â | Â | Â | Â | Â |
Golan et al. 1999 US [33] | 3 | 3 | Societal | The cost of ESRD (dialysis & transplant), ACEIs and screening | 15.63 years/11.82 QALYs with ‘treat all’, | ‘Treat all’ vs ‘screen for MiA’: $300a | ‘Treat all’ vs ‘screen for MiA’: €299 | Very cost-effective [‘Treat all’ vs. ‘screen for MiA’: €8,062/QALY] |
15.59 years/11.78 QALYs with ‘screen for MiA’, 15.39 years/11.59 QALYs with ‘screen for gross proteinuria’ | ||||||||
Sakthong et al. 2001 Thailand [34] | 8 | 8 | Not mentioned | The cost of ESRD (haemodialysis) and ACEI | 9.04 years with enalapril, 7.54 years with control | -$1,198 [1999] | -€1,269 | Cost saving [Enalapril] |
Rosen et al. 2005 US [35] | 3 | 3 | Medicare and societal | (1) Medicare perspective: direct medical costs and future health care costs. | 10.55 years/8.36 QALYs with Medicare first-dollar coverage of ACEIs, 10.30 years /8.13 QALYs with at the time practice | -$1,606 [2003] | -€1,453 | Cost saving [Medicare first-dollar coverage of ACEIs] |
(2) Societal perspective: additional analyses included productivity gains and losses, caregiver time costs | ||||||||
Campbell et al. 2007 US [36] | 3 | 3 | Health payer | Direct medical costs of nephropathy, CVD, and ACEIs |  | -$772 for normoalbuminuria on diagnosis, -$7,098 for MiA on diagnosis, $7,987 for MaA on diagnosis [2005] | -€658 for normoalbuminuria on diagnosis, -€6,048 for MiA on diagnosis, €6,806 for MaA on diagnosis | Cost-neutral [ACEIs used on normoalbuminuria] |
Cost saving [ACEIs on MiA] | ||||||||
Adarkwah et al. 2010 Germany [37] | 3 | 3 | the German statutory health insurance | The cost of ESRD (dialysis & transplant), ACEIs, ARBs and screening | 15.21 QALYs with ‘treat all’, | ‘Treat all’ vs. ‘placebo’: -€16,024 [2006] | ‘Treat all’ vs. ‘placebo’: -€16,841 | Cost saving [Treat all using ACEIs] |
15.14 QALYs with ‘screen for MiA’, 14.83 QALYs with ‘screen for MaA’, 14.46 QALYs with ‘placebo’ | ||||||||
Adarkwah et al. 2011 Netherlands [38] | 1.5 | 4 | Health care | The cost of ESRD (dialysis & transplant), ACEIs, ARBs and screening | 19.63 QALYs with ‘treat all’, 19.54 QALYs with ‘screen for MiA’, 19.15 with ‘screen for MaA’ | ‘Treat all’ vs. ‘screen for MiA’: -€2,719, ‘treat all’ vs. ‘screen for MaA’: -€12,356 [2010] | ‘Treat all’ vs. ‘screen for MiA’: -€2,749, ‘treat all’ vs. ‘screen for MaA’: -€12,492 | Cost saving [Treat all using ACEIs] |
ARBs | Â | Â | Â | Â | Â | Â | Â | Â |
Losartan | Â | Â | Â | Â | Â | Â | Â | Â |
Herman WH et al., 2003 US [39] | none | 3 | Health care system | The cost of ESRD (hemodialysis) and losartan therapy |  | Over 3.5 years: -$3,522 [2001] | Over 3.5 years: -€3,306 | Cost saving [losartan] |
Souchet T et al., 2003 France [40] | none | 8.1%b | French health care system | The cost of ESRD (dialysis) and losartan therapy |  | Over 3.5 years: -€3,863 [2002] | Over 3.5 years: -€4,522 | Cost saving [losartan] |
Burgess ED et al., 2004 Canada [41] | none | none | Health care system | The cost of ESRD (dialysis & transplant) and losartan therapy |  | Over 3.5 years: -$3,675a | Over 3.5 years: -€3,368 | Cost saving [losartan] |
Szucs TD et al., 2004 Switzerland [42] | none | none | Swiss health care payer | The cost of ESRD (dialysis & transplant) and losartan therapy (only the insurance-paid part) |  | Over 3.5 years: -CHF4,084a | Over 3.5 years: -€3,660 | Cost saving [losartan] |
Seng WK et al., 2005 Hong Kong [32] (only data of Hong Kong were included) | 3 | 3 | Health care system | The cost of ESRD (dialysis) and losartan therapy |  | -$515 [2004] | -€413 | Cost-neutral [losartan] |
Arredondo A et al., 2005 Mexico [43] | 3 | 3 | Health care system | The cost of ESRD (dialysis), diabetes and losartan therapy | 0.697 life years gained for losartan | -M$24,073 [2004] | -€1,861 | Cost saving [losartan] |
Vora J et al., 2005 UK [44] | 3.5 | 3.5 | The UK National Health Service (NHS) | The cost of ESRD (dialysis) and losartan therapy | 7.82 life years with losartan, 7.38 life years with placebo (0.44 life years gained for losartan) | -£6,622 [2004] | -€9,182 | Cost saving [losartan] |
Carides GW et al., 2006 US [45] | 3 | 3 | Health care system | The cost of ESRD (dialysis), diabetes and losartan therapy | 0.697 life years gained for losartan | -$24,632 [2002] | -€22,757 | Cost saving [losartan] |
Stafylas PC et al., 2007 Greece [46] | 3 | 3 | The Greek social insurance system | The cost of ESRD (dialysis & transplant) and 75% of drug treatment costs |  | Over 3.5 years: -€1,665.43 [2003] | Over 3.5 years: -€2,079 | Cost saving [losartan] |
de Portu S et al., 2011 Italy [47] | 3 | 3 | National Health care Service | The cost of ESRD (hemodialysis) and losartan therapy |  | -€3,602.98 [2009] | -€3,664 | Cost saving [losartan] |
de Portu S et al., 2011 France [47] | 3 | 3 | Health Insurance | The cost of ESRD (hemodialysis) and losartan therapy |  | -€4,531.35 [2009] | -€4,641 | Cost saving [losartan] |
de Portu S et al., 2011 Germany [47] | 3 | 3 | Health Insurance | The cost of ESRD (hemodialysis) and losartan therapy |  | -€3,019.66 [2009] | -€3,062 | Cost saving [losartan] |
de Portu S et al., 2011 Switzerland [47] | 3 | 3 | Medical Insurance | The cost of ESRD (hemodialysis) and losartan therapy |  | -€3,949.50 [2009] | -€3,977 | Cost saving [losartan] |
de Portu S et al., 2011 US [47] | 3 | 3 | Centers for Medicare & Medicaid Services | The cost of ESRD (hemodialysis) and losartan therapy |  | -€3,855.50 [2009] | -€4,007 | Cost saving [losartan] |
Irbesartan | Â | Â | Â | Â | Â | Â | Â | Â |
Rodby RA et al., 2003 US [48] | 3 | 3 | Health care system | The cost of ESRD (dialysis & transplant), hospitalizations, irbesartan & concomitant antihypertensive drugs | 8.225 years with irbesartan, 7.484 years with control (0.741 years gained for irbesartan) | -$15,607 [2000] | -€14,987 | Cost saving [irbesartan] |
Palmer AJ et al., 2003 Belgium [49] | 3 | 3 | Institut National d’Assurance de Maladie et Invalidite’ (INAMI) | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 8.57 years with irbesartan, 7.95 years with control (0.62 years gained for irbesartan) | -€11,885 [2002] | -€14,231 | Cost saving [irbesartan] |
Palmer AJ et al., 2003 France [49] | 3 | 3 | Social security | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 8.58 years with irbesartan, 7.97 years with control (0.61 years gained for irbesartan) | -€16,345 [2002] | -€19,132 | Cost saving [irbesartan] |
Coyle D et al., 2004 Canada [50] | 5 | 5 | Third party payer | The cost of ESRD (dialysis & transplant), irbesartan & concomitant antihypertensive drugs and other medical costs | 6.80 years with irbesartan, 6.37 years with control (0.43 years gained for irbesartan) | -CAD12,564 [2001] | -€11,457 | Cost saving [irbesartan] |
Palmer AJ et al., 2004 UK [51] | 1.5 | 6 | National Health Service (NHS) payer | The cost of ESRD (dialysis & transplant) and irbesartan & concomitant antihypertensive drugs | 0.58 years gained for irbesartan vs control | -£4,978a | -€7,075 | Cost saving [irbesartan] |
Palmer AJ et al., 2004 US [52] | 3 | 3 | Third party reimbursement | The cost of ESRD (dialysis & transplant) and irbesartan | 11.46 years with ‘early irbesartan’, 10.54 years with ‘late irbesartan’, 10.50 years with control (0.96 years gained for irbesartan vs control) | Early irbesartan vs. control: -$11,922, late irbesartan vs. control: -$3,252 [2000] | Early irbesartan vs. control: -€11,448, late irbesartan vs. control: -€3,123 | Cost saving [early irbesartan] |
Palmer AJ et al., 2005 Spain [53] | 3 | 3 | Third party payer | The cost of ESRD (dialysis & transplant) and irbesartan | 12.37 years with ‘early irbesartan’, 11.53 years with control (0.84 years gained for irbesartan) | -€11,082a | -€12,971 | Cost saving [early irbesartan] |
Palmer AJ et al., 2006 Switzerland [54] | 5 | 5 | Third party Swiss health insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 10.37 years with ‘early irbesartan’, 9.80 years with control (0.57 years gained for irbesartan) | -CHF21,487 [2003] | -€19,257 | Cost saving [early irbesartan] |
Palmer AJ et al., 2006 France [55] | 3 | 3 | Third party French social security insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 12.17 years /10.55 QALYs with ‘early irbesartan’, 11.27 years /9.58 QALYs with ‘late irbesartan’, 11.23 years /9.52 QALYs with control (0.94 years /1.03 QALYs gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -€22,314, ‘late irbesartan vs. control’: -€6,619 [2002] | ‘Early irbesartan’ vs. control: -€26,119, ‘late irbesartan’ vs. control: -€7,748 | Cost saving [early irbesartan] |
Palmer AJ et al., 2007 Hungary [56] | 5 | 5 | Third-party Hungarian health insurance payer | The cost of ESRD (dialysis & transplant) and irbesartan | 8.16 years with ‘early irbesartan’, 7.62 years with control (0.54 years gained for irbesartan) | -HUF519,993 [2002] | -€2,564 | Cost saving [early irbesartan] |
Palmer AJ, 2007 UK [57] | 3.5 | 3.5 | Third party UK National Health Service (NHS) payer | The cost of ESRD (dialysis & transplant) and irbesartan | 11.00 years with ‘early irbesartan’, 10.20 years with ‘late irbesartan’, 10.18 years with control (0.82 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -£3,801, ‘late irbesartan’ vs. control:- £1,491 [2002] | ‘Early irbesartan’ vs. control: -€5,532, ‘late irbesartan’ vs. control: -€2,170 | Cost saving [early irbesartan] |
Coyle D et al., 2007 Canada [58] | 5 | 5 | Canadian health and social care system | All direct costs, including the costs of health, social services, long-term care. | 11.52 years with ‘early irbesartan’, 11.06 years with ‘late irbesartan’, 10.90 years with control (0.62 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -CAD68,400, ‘late irbesartan’ vs. control: -CAD14,300 [2006] | ‘Early irbesartan’ vs. control: -€57,871, ‘late irbesartan’ vs. control: -€12,099 | Cost saving [early irbesartan] |
Yang W.C. et al., 2007 Taiwan [59] | 3 | 3 | Third-party payer in Taiwan (Taiwan National Health Insurance Program) | The cost of ESRD (dialysis & transplant) and irbesartan | 12.003 years with ‘early irbesartan’, 11.332 years with ‘late irbesartan’, 11.223 years with control (0.780 years gained for irbesartan vs control) | ‘Early irbesartan’ vs. control: -$7,603, ‘late irbesartan’ vs. control: -$3,233 [2004] |  | Cost saving [early irbesartan] |
Annemans L et al., 2008 China, Taiwan, Malaysia, Thailand, South Korea [60] | 5 | 5 | Third party payer | The cost of ESRD (dialysis & transplant) and irbesartan | ‘Early irbesartan’ strategy had the longest life expectancy (no detail data) | The least expensive strategy: ‘early irbesartan’ (no detail data) |  | Cost saving [early irbesartan] |
Valsartan | Â | Â | Â | Â | Â | Â | Â | Â |
Smith DG et al., 2004 US [61] | 3 | 3 | Third-party payer | Medical care costs including costs of study drugs, routine health care services, and aggregate estimates of medical care associated with the various health states. | 6.390 QALYs with valsartan, 5.835 QALYs with amlodipine (0.555 QALYs gained for valsartan) | -$32,412 [2001] | -€30,424 | Cost saving [valsartan] |