ECONOMIC-EVALUATION OF THE CONTRIBUTION O F CAPTOPRIL IN THE TREATMENT OF DIABETIC NEPHROPATHY - A COST-BENEFIT ANALYTICAL APPROACH

A controlled, double-blind trial, carried out by Lewis and al., has sh own that in 409 patients presenting with insulin-dependent diabetes, p roteinuria in excess of 500 mg/day and plasma creatinine of less than 221 mu mol/l, captopril treatment was able to reduce the risk of combi ned events (mortality, renal dialysis and transplantation) by 50% (p = 0,006) and that of doubling plasma creatinine by 48% (p = 0,007). We evaluated the cost/benefit ratio of this treatment on the basis of the medical outcome of this study and economic data for the French health -care system. The cost of the treatment by captopril is totaly offset by the reduction in costs obtained by postponing dialysis and kidney t ransplantation, concomitant antihypertensive treatment and hospitalisa tion. In this study, the health expenditure savings in the captopril g roup amounted to 6 million French Francs. Spending 100.- Francs on cap topril to treat diabetic nephropathy yielded savings of 575.- Francs. This economic advantage, plus a reduction of 6 in the number of deaths , corresponding to 131 life-years saved, demonstrates the favorable co st-benefit ratio of this treatment strategy.