Cost–effectiveness of angiotensin-converting enzyme inhibitors in nondiabetic advanced renal disease

Abstract

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.

Keywords::

• advanced renal disease
• angiotensin-converting enzyme inhibitors
• cost–effectiveness
• decision modeling
• hypertension

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.