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Table 4 Main results of economic evaluations on ACEIs and ARBs

From: Economic evaluations of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in type 2 diabetic nephropathy: a systematic review

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         
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         
Losartan         
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         
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         
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]
  1. a: In which year the value of money standardized was not clear. It was assumed to be one year before the publication.
  2. b: The total discount rate within time horizon, not annually.