MODELING AND COSTING THE CONSEQUENCES OF USING AN ACE-INHIBITOR TO SLOW THE PROGRESSION OF RENAL-FAILURE IN TYPE-I DIABETIC-PATIENTS

Antihypertensive drugs slow the progressive decline in renal function seen in patients with insulin-dependent diabetes and nephropathy. In a recent study, the ACE inhibitor captopril protected against this dete rioration in renal function. We developed an economic model to analyse the cost impact of ACE inhibitor treatment on progression to endstage renal failure (ESRF) in diabetic patients over 4 years. Two scenarios were compared: one describing the progression of a cohort of 1000 pat ients receiving 25 mg captopril three times daily, and the other for a n equivalent cohort without such prophylactic treatment. Previously pu blished data were used to estimate the transition rates for each stage from the onset of renal failure until death. All direct costs were di scounted by an annual rate of 6%, and were subjected to sensitivity an alysis. The discounted cost saving of ACE inhibitor treatment for a co hort of 1000 patients was estimated as pound 0.95 million over 4 years . Under sensitivity analysis, these results were very robust to variat ions in the costs of ESRF treatment. Prophylactic treatment with ACE i nhibitors was predicted to provide substantial increases in life expec tancy and reduction in the incidence of ESRF, while also providing sig nificant economic savings.