The early use of irbesartan in hypertensive type 2 diabetic patients with microalbuminuria will improve life expectancy and reduce costs. Initiating irbesartan later, when overt nephropathy is present, also leads to life and savings costs, albeit to a significantly lesser degree.
Dr. Andrew J. Palmer, from the CORE-Center for Outcomes Research in Basel, Switzerland and colleagues report their research in the August issue of Diabetes Care.
Several trials have recently reported that irbesartan has renoprotective effects at various stages of renal disease, independent of its antihypertensive effects.
The goal of the current study was to pinpoint the stage of diabetic renal disease that initiation of irbesartan would be most cost-effective. To do this, Dr. Palmer’s team used a Markov model to simulate progression from microalbuminuria to overt nephropathy, doubling of serum creatinine, end-stage renal disease (ESRD), and death in 1,000 hypertensive type 2 diabetics treated with two irbesartan strategies. The early irbesartan strategy called for initiating the drug (300 mg daily) for microalbuminuria, whereas the late irbesartan strategy called for the same regimen started when overt nephropathy developed.
Compared with a control strategy (standard antihypertensive therapy excluding ACE inhibitors, other angiotensin-2 receptor antagonists and dihydropyridine calcium channel blockers), early irbesartan was projected to save roughly U.S. $11.9 dollars over 25 years compared with a savings of $3.3 million for late irbesartan.
While the early strategy added 1,550 of undiscounted life-years in 1,000 patients, the late strategy added just 71 undiscounted life-years.
Based on the results of this model, early irbesartan will lead to the "greatest decreases in the incidence of ESRD, prolongation of life, and savings of money," the team notes. These findings were "robust" under a wide range of plausible assumptions, they add. Diabetes Care 2004;27:1897-1903.