Table 3.
Study, country/region | Source of effectiveness data | Intervention group | Control group | Decision model type | Time horizon (years) | Evaluation type |
---|---|---|---|---|---|---|
ACEIs |
|
|
|
|
|
|
Golan et al. 1999 US [33] |
UERNN, LEAPP and EADN trial |
‘Treat all’ strategya |
(1) Screen for MiAb; |
Markov model with 5 states |
10 |
CEA & CUA (Life-years & QALYs) |
(2) Screen for gross proteinuriac. | ||||||
Sakthong et al. 2001 Thailand [34] |
LEAN trial and the opinion of nephrologists |
Enalapril at the dose of 10 mg/day |
Placebo |
Markov model with 4 stages |
25 |
CEA (Life years) |
Rosen et al. 2005 US [35] |
UERNN, EADN, LEAN, H-MH studies and HOPE trial |
Medicare first-dollar coverage of ACEIs |
Year 2005’s Medicare practice |
Markov model adding a cardiovascular events component. |
lifetime |
CEA & CUA (Life-years & QALYs) |
Campbell et al. 2007 US [36] |
UERNN, EADN, H-MH studies and IRMA-2 trial |
ACEI therapy in normoalbuminimuric, microalbuminuric, and macroalbuminuric patients |
No ACEI initiation in patients |
Markov model |
8 |
CEA (CVD event avoided, life saved, dialysis prevented, composite endpoint avoided) |
Adarkwah et al. 2010 Germany [37] |
EADN and two meta-analyses |
‘Treat all’ strategya |
(1) Screen for MiAb; |
Markov model with 5 states |
50 |
CUA (QALY) |
(2) Screen for MaAc; | ||||||
(3) no-screening and no-treatment alternative. | ||||||
Adarkwah et al. 2011 Netherlands [38] |
EADN and two meta-analyses |
‘Treat all’ strategya |
(1) Screen for MiAb; |
Markov model with 5 states |
50 |
CUA (QALY) |
(2) Screen for MaAc. | ||||||
ARBs |
|
|
|
|
|
|
Losartan |
|
|
|
|
|
|
Herman et al. 2003 US [39] |
RENAAL trial |
Losartan |
Placebod |
A regression-based method |
3.5 / 4 |
CEA (Number of ESRD days) |
Souchet et al. 2003 France [40] |
RENAAL trial |
Losartan (initial daily dosing of losartan was 50 mg, with the possibility of titration to 100 mg/day) |
Placebod |
A regression-based method |
3.5 / 4 |
CEA (Number of ESRD days) |
Burgess et al. 2004 Canada [41] |
RENAAL trial |
Losartan |
Placebod |
A regression-based method |
3.5 / 4 |
CEA (Number of ESRD days) |
Szucs et al. 2004 Switzerland [42] |
RENAAL trial |
Losartan (initial daily dosing of losartan was 50 mg, with the possibility of titration to 100 mg/day) |
Placebod |
A regression-based method |
3.5 / 4 |
CEA (Number of ESRD days) |
Seng et al. 2005 Hong Kong [32] (only data of Hong Kong were included) |
RENAAL trial |
Losartan |
Placebod |
A regression-based method |
3.5 |
CEA (Number of ESRD days) |
Arredondo et al. 2005 Mexico [43]] |
RENAAL trial |
Losartan |
Placebod |
A variation of the cumulative incidence competing risk method / Weibull model |
25 (life time) |
CEA (Cumulative incidence of ESRD, life expectancy) |
Vora et al. 2005 UK [44] |
RENAAL trial |
Losartan (50–100 mg QD) |
Conventional antihypertensive treatmentd (excluding ACEIs or angiotensin II antagonists) |
Weibull model |
life time |
CEA (Cumulative incidence of ESRD, life expectancy) |
Carides et al. 2006 US [45] |
RENAAL trial |
Losartan |
Placebod |
A cumulative incidence competing risk method / Weibull model |
25 (life time) |
CEA (Cumulative incidence of ESRD, life expectancy) |
Stafylas et al. 2007 Greece [46] |
RENAAL trial |
Losartan (50–100 mg QD) |
Placebod |
Markov model with 6 states |
3.5/4 |
CEA (Number of ESRD days) |
de Portu et al. 2011 Italy, France, Germany, Switzerland, US [47] |
RENAAL trial |
Losartan |
Standard cared |
Standard methods by comparing the economic outcomes deriving from additional losartan to standard care vs standard care alone |
3.4 |
CEA (Number of ESRD days) |
Irbesartan |
|
|
|
|
|
|
Rodby RA et al. 2003 US [48] |
IDNT trial |
Irbesartan titrated from 75 to 300 mg/day |
(1) ‘Control’d; |
Markov model with 5 stages |
25 |
CEA (Life expectancy) |
(2) Amlodipine titrated from 2.5 to 10 mg/day. | ||||||
Palmer AJ et al. 2003 Belgium, France [49] |
IDNT trial |
Irbesartan titrated from 75 to 300 mg/day |
(1) ‘Control’d; |
Markov model with 5 stages |
25 |
CEA (Life expectancy) |
(2) Amlodipine titrated from 2.5 to 10 mg/day. | ||||||
Coyle D et al. 2004 Canada [50] |
IDNT trial |
Irbessartan |
(1) Amlodipine; |
Markov model with 5 stages |
25 |
CEA (Life expectancy) |
(2) Standard cared | ||||||
Palmer AJ et al. 2004 UK [51] |
IDNT trial |
Irbesartan 300 mg per day |
(1) ‘Control’d; |
Markov model with 5 stages |
25 |
CEA (Life expectancy) |
(2) Amlodipine 10 mg per day. | ||||||
Palmer AJ et al. 2004 US [52] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
(1) ‘Control’d; |
Markov model with 7 stages |
25 |
CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
(2) ‘Late irbesartan’f | ||||||
Palmer AJ et al. 2005 Spain [53] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
Standard antihypertensive medicationsd |
Markov model with 7 stages |
25 |
CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
Palmer AJ et al. 2006 Switzerland [54] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
Conventional antihypertensive treatmentd initiated when patients had developed MiA. |
Markov model with 7 stages |
25 |
CEA (Years free of ESRD, cumulative incidence of ESRD, life expectancy) |
Palmer AJ et al. 2006 France [55] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
(1) ‘Control’d; |
Markov model with 7 stages |
25 |
CEA & CUA (Years free of ESRD, life expectancy, QALY) |
(2) ‘Late irbesartan’f | ||||||
Palmer AJ et al. 2007 Hungary [56] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
‘Placebo’d: standard antihypertensive medications initiated when patients developed MiA. |
Markov model with 7 stages |
25 |
CEA (Years free of ESRD, cumulative incidence ESRD, life expectancy) |
Palmer AJ et al. 2007 UK [57] |
IRMA-2 study and IDNT trial |
‘Early irbesartan’e |
(1) ‘Control’d; |
Markov model with 7 stages |
25 |
CEA (Years free of ESRD, cumulative Incidence of ESRD, life expectancy) |
(2) ‘Late irbesartan’f | ||||||
Coyle D et al. 2007 Canada [58] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
(1) ‘Late irbesartan’f; |
Markov model with 7 stages |
25 |
CEA (Life expectancy) |
(2) ‘Conventional’d | ||||||
Yang W.C. et al. 2007 Taiwan [59] |
IRMA-2 study and IDNT |
‘Early irbesartan’e |
(1) ‘Standard’d; |
Markov model with 7 stages |
25 |
CEA (Life expectancy, number of years free of ESRD, cumulative incidence of ESRD) |
(2) ‘Late irbesartan’f; | ||||||
(3) ‘Late amlodipine’g | ||||||
Annemans et al. 2008 China, Taiwan, Malaysia, Thailand, South Korea [60] |
IRMA-2 study and IDNT trial |
‘Early irbesartan’e |
(1) ‘Standard’d; |
Markov model with 7 stages |
25 |
CEA (Cumulative incidence of ESRD, number of days in dialysis, number of years free of ESRD, life expectancy) |
(2) ‘Late irbesartan’f; | ||||||
(3) ‘Late amlodipine’g | ||||||
Valsartan |
|
|
|
|
|
|
Smith DG et al. 2004 US [61] | MARVAL study | Valsartan | Amlodipine | Markov model with 7 stages | 8 | CUA (Quality-adjusted survival) |
a: no screening was performed at all and patients started on ACEI therapy at the time of diagnosing type 2 diabetes.
b: patients were screened for MiA once a year and ACEI treatment was started if the test result is positive.
c: patients were screened for MaA once a year and ACEI treatment was started if the test result is positive.
d: standard antihypertensive therapy alone, excluding the use of ACEIs, ARBs.
e: standard antihypertensive therapy plus administration of irbesartan 300 mg/d at the onset of MiA.
f: standard antihypertensive therapy plus administration of irbesartan 300 mg/d once the patients reach the advanced diabetic nephropathy stage.
g: standard antihypertensive therapy plus administration of amlodipine titrated from 5 to 10 mg/d once the patients reach the advanced diabetic nephropathy stage.
UERNN = Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus; LEAPP = Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients; EADN = The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy; LEAN = Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus; H-MH = Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy; HOPE = The Heart Outcomes Prevention Evaluation; RENAAL = The reduction of endpoints in non-insulin dependent diabetes mellitus with the angiotensin II antagonist losartan; IDNT = The irbesartan in diabetic nephropathy trial; IMRA-2 = The irbesartan in reduction of microalbuminuria-2; MARVAL = The microalbuminuria reduction with valsartan.
CEA = cost-effectiveness analysis; CUA = cost-utility analysis.