Advanced Search

Cost Effectiveness of ACE Inhibitor Treatment for Patients with Type 1 Diabetes Mellitus

Contents:

Author Info

  • Frederick B. Dong

    (Battelle, Centers for Public Health Research and Evaluation, Seattle, Washington, USA)

  • Stephen W. Sorensen

    (Centers for Disease Control and Prevention, Atlanta, Georgia, USA)

  • Diane L. Manninen

    (Battelle, Centers for Public Health Research and Evaluation, Seattle, Washington, USA)

  • Theodore J. Thompson

    (Centers for Disease Control and Prevention, Atlanta, Georgia, USA)

  • Venkat Narayan

    (Centers for Disease Control and Prevention, Atlanta, Georgia, USA)

  • Carlyn E. Orians

    (Battelle, Centers for Public Health Research and Evaluation, Seattle, Washington, USA)

  • Edward W. Gregg

    (Centers for Disease Control and Prevention, Atlanta, Georgia, USA)

  • Richard C. Eastman

    (Cygnus, Inc., Redwood City, California, USA)

  • Erik J. Dasbach

    (Merck & Co., West Point, Pennsylvania, USA)

  • William H. Herman

    (University of Michigan, Internal Medicine and Epidemiology, Ann Arbor, Michigan, USA)

  • Jeffrey M. Newman

    (Sutter Health Institute for Research and Education, San Francisco, California, USA)

  • Andrew S. Narva

    (Indian Health Kidney Disease Program, Albuquerque, New Mexico, USA)

  • David J. Ballard

    (Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas, USA)

  • Michael M. Engelgau

    (Centers for Disease Control and Prevention, Atlanta, Georgia, USA)

Registered author(s):

    Abstract

    Objective: Current guidelines recommend treating patients with type 1 diabetes mellitus with ACE inhibitors after the onset of microalbuminuria. Recent clinical trials have shown ACE inhibitors can affect the development of nephropathy when initiated prior to the onset of microalbuminuria. Our objective is to examine the cost effectiveness of treating adults aged over 20 years with an ACE inhibitor (captopril) immediately following diagnosis of type 1 diabetes versus treating them after the onset of microalbuminuria. Design: Using a semi-Markov model, we calculated four main outcome measures: lifetime direct medical costs (discounted), QALYs, cumulative incidence of end-stage renal disease (ESRD), and number of days of ESRD over a lifetime. Medical costs are in 1999 US dollars. Setting: All analyses were from the viewpoint of a single US payer responsible for all direct medical costs, including screening for microalbuminuria, ACE inhibitor treatment (captopril), management of major diabetic complications, and routine annual medical costs not specific to diabetes. Methods: We applied the model to a hypothetical cohort of 10 Results: We estimated that the incremental cost of early use of captopril for the average adult with type 1 diabetes is $US27 Conclusion: This model, with its underlying assumptions and data, suggests that early treatment with captopril provides modest benefit at reasonable cost effectiveness, from the US single-payer perspective, in the prevention of ESRD compared with delaying treatment until diagnosis of microalbuminuria. Early treatment with other ACE inhibitors will provide similar cost effectiveness if they have equivalent efficacy, compliance and price per dose. Treatment may be considered among patients at age 20 years with new onset of type 1 diabetes. This conclusion is sensitive to the extent that ACE inhibitors delay onset of microalbuminuria. Other factors such as the patient's age and glycaemic level must be considered when deciding to initiate early treatment.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://pharmacoeconomics.adisonline.com/pt/re/phe/pdfhandler.00019053-200422150-00005.pdf
    Download Restriction: Pay per view
    File URL: http://pharmacoeconomics.adisonline.com/pt/re/phe/fulltext.00019053-200422150-00005.htm
    Download Restriction: Pay per view

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

    Volume (Year): 22 (2004)
    Issue (Month): 15 ()
    Pages: 1015-1027
    Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
    Handle: RePEc:wkh:phecon:v:22:y:2004:i:15:p:1015-1027

    Contact details of provider:
    Web page: http://pharmacoeconomics.adisonline.com/

    For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).

    Related research

    Keywords: ACE-inhibitors; Captopril; Cost-utility; Diabetic-nephropathies;

    Find related papers by JEL classification:

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:wkh:phecon:v:22:y:2004:i:15:p:1015-1027

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dave Dustin).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.