Source: Circulation  |  Posted 8 years ago

Use of irbesartan is less costly and prolongs life expectancy beyond that seen with amlodipine or standard care in patients with diabetic neuropathy and hypertension, according to economic evaluation of these treatments in Canada.

The angiotensin II receptor antagonist irbesartan was shown in a recent study to reduce the risk of onset and progression of end-stage renal disease (ESRD) and all-cause mortality in patients with type 2 diabetes, hypertension and proteinuria. Furthermore, irbesartan was shown to be superior to both standard care and the calcium channel blocker amlodipine.

Douglas Coyle, MSc, with the Ottawa Hospital, Ontario, and colleagues evaluated the cost comparison between irbesartan, amlodipine, and standard care when used to treat patients with diabetic neuropathy and hypertension in Canada.

The study employed a Markov economic model that consisted of data from the Irbesartan in Diabetic Nephropathy Trial (IDNT) and used Canadian estimates of resource allocation and cost.

The IDNT was a comparative trial of amlodipine, irbesartan, and standard care without the use of angiotensin II receptor antagonists or calcium channel blockers in patients with diabetic neuropathy and hypertension. The trial provided an average of 3-years of follow-up data.

Irbesartan dominance was evident in both deterministic and probabilistic analyses, and persisted in univariate analysis. The net benefit of irbesartan was $25,000-$33,000 over standard care and $30,000-$37,000 over amlodipine, depending upon value of life-year.

Irbesartan treatment was also associated with longer life expectancy when compared to the other treatment options, 6.8 years versus 6.4 years for standard care and 6.5 years for amlodipine treatment.

In addition, amlodipine was found to be slightly more effective at prolonging life when compared to standard care, yet was more costly, with an unattractive incremental cost-effectiveness ratio of at least $67,000.

Based on these findings, the authors conclude that "irbesartan would lead to a reduction in medical costs with an increase in life expectancy when compared with amlodipine or standard care."