Cost-effectiveness of angiotensin receptor blockers in patients with type 2 diabetes mellitus and nephropathy in Israel

Background: Besides its toll on human life, the steep rise in the rate of diabetes as the cause of end stage renal disease (ESRD), with the consequent increase in the need for renal replacement therapy has created a substantial economic burden on health care systems. Clinical trials have found angiotensin receptor blockers (ARBs) to be more beneficial than traditional antihypertensive therapy in patients with type 2 diabetic nephropathy (DN). However, in Israel, ARBs are not considered first-line therapy. Objectives: To determine the cost-effectiveness of ARB treatment for diabetic nephropathy in the Israeli health care system. Methods: A Markov model was constructed wherein utility values were assigned to each consecutive health state of diabetic nephropathy. The transition probabilities from one state to another were derived from reported clinical trials. Quality-adjusted life years (QALYs) were calculated and sensitivity analysis was performed. For the economic evaluation, the researchers used data from the Israeli health system. Results: Treatment with ARBs over a 3-year period yielded a higher QALY than conventional anti-hypertensive treatment (2.63 vs. 2.59) and a lower cost (NIS 36,678 vs. NIS 39,932). For a time horizon of 10 years, the cost difference increased to NIS 50,000, with a 20% reduction in the number of patients with ESRD. Sensitivity analysis revealed that these results were valid over a wide range of parameters. Conclusions: The use of ARBs to delay ESRD appears to be cost-effective. We recommend that ARBs be considered in Israel as first-line treatment for patients with type 2 diabetic nephropathy.