Cost-Effectiveness of Aliskiren in Type 2 Diabetes, Hypertension, and Albuminuria

• Published in: Journal of the American Society of Nephrology Vol. 20; no. 10; pp. 2205 - 2213
• Main Authors: DELEA, Thomas E, SOFRYGIN, Oleg, PALMER, James L, HELEN LAU, MUNK, Veronica C, SUNG, Jennifer, CHARNEY, Alan, PARVING, Hans-Henrik, SULLIVAN, Sean D
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.10.2009
• Subjects: Albuminuria - drug therapy; Albuminuria - economics; Amides - therapeutic use; Biological and medical sciences; Biphenyl Compounds - therapeutic use; Clinical Epidemiology; Cost-Benefit Analysis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - economics; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - drug therapy; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fumarates - therapeutic use; Health Care Costs; Humans; Hypertension - drug therapy; Hypertension - economics; Losartan - administration & dosage; Losartan - therapeutic use; Medical sciences; Nephrology. Urinary tract diseases; Quality-Adjusted Life Years; Tetrazoles - therapeutic use; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Endocrinopathy; Type 2 diabetes; Hypertension; Nephrology; Urinary system disease; Enzyme; Enzyme inhibitor; Aliskiren; Non peptide compound; Metabolic diseases; Cardiovascular disease; Urology; Peptidases; Renin; Health economy; Hydrolases; Antihypertensive agent; Aspartic endopeptidases; Cost efficiency analysis; Proteinuria
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2008111144

The Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) trial demonstrated that adding aliskiren, an oral direct renin inhibitor, at a dosage of 300 mg/d to the highest approved dosage of losartan and optimal antihypertensive therapy reduces albuminuria over 6 mo among patients with type 2 diabetes, hypertension, and albuminuria. The cost-effectiveness of this therapy, however, is unknown. Here, we used a Markov model to project progression to ESRD, life years, quality-adjusted life years, and lifetime costs for aliskiren plus losartan versus losartan. We used data from the AVOID study and the Irbesartan in Diabetic Nephropathy Trial (IDNT) to estimate probabilities of progression of renal disease. We estimated probabilities of mortality for ESRD and other comorbidities using data from the US Renal Data System, US Vital Statistics, and published studies. We based pharmacy costs on wholesale acquisition costs and based costs of ESRD and transplantation on data from the US Renal Data System. We found that adding aliskiren to losartan increased time free of ESRD, life expectancy, and quality-adjusted life expectancy by 0.1772, 0.1021, and 0.0967 yr, respectively. Total expected lifetime health care costs increased by $2952, reflecting the higher pharmacy costs of aliskiren and losartan ($7769), which were partially offset by savings in costs of ESRD ($4860). We estimated the cost-effectiveness of aliskiren to be $30,500 per quality-adjusted life year gained. In conclusion, adding aliskiren to losartan and optimal therapy in patients with type 2 diabetes, hypertension, and albuminuria may be cost-effective from a US health care system perspective.