BACKGROUND: National and international clinical guidelines do not consistently recommend treating nondiabetic proteinuric patients with advanced renal disease with an angiotensin-converting enzyme (ACE) inhibitor. OBJECTIVE: To determine the cost-effectiveness of ACE inhibitor therapy in nondiabetic proteinuric patients with advanced renal disease in Germany. METHODS: Two strategies were compared: treating patients with advanced renal disease with an ACE inhibitor and no ACE inhibitor treatment. A lifetime Markov decision model was developed using published data on costs and health outcomes and simulated the progression of renal disease with costs and benefits discounted at 3%. A statutory health insurance perspective was adopted. RESULTS: In the base-case analysis, ACE inhibitor treatment is associated with lower costs and higher benefit and therefore dominates the no-treatment strategy. A probabilistic sensitivity analysis demonstrates that the probability of savings is 80%. CONCLUSION: ACE inhibitor treatment for nondiabetic patients with advanced renal disease is highly cost effective.
BACKGROUND: National and international clinical guidelines do not consistently recommend treating nondiabetic proteinuricpatients with advanced renal disease with an angiotensin-converting enzyme (ACE) inhibitor. OBJECTIVE: To determine the cost-effectiveness of ACE inhibitor therapy in nondiabetic proteinuricpatients with advanced renal disease in Germany. METHODS: Two strategies were compared: treating patients with advanced renal disease with an ACE inhibitor and no ACE inhibitor treatment. A lifetime Markov decision model was developed using published data on costs and health outcomes and simulated the progression of renal disease with costs and benefits discounted at 3%. A statutory health insurance perspective was adopted. RESULTS: In the base-case analysis, ACE inhibitor treatment is associated with lower costs and higher benefit and therefore dominates the no-treatment strategy. A probabilistic sensitivity analysis demonstrates that the probability of savings is 80%. CONCLUSION:ACE inhibitor treatment for nondiabeticpatients with advanced renal disease is highly cost effective.
Authors: Paul Kairys; Thomas Frese; Paul Voigt; Johannes Horn; Matthias Girndt; Rafael Mikolajczyk Journal: PLoS One Date: 2022-01-05 Impact factor: 3.240