Irbesartan Cost-Effective Treatment of Diabetic Kidney Disease in Patients with Type 2 Diabetes

Economic analyses reveals irbesartan Could provide U.S. health care savings of up to $2.3 billion in three years

CHICAGO, November 17, 2002 Up to $2.3 billion in total health care cost savings could be achieved in just three years if Americans with type 2 diabetes and kidney disease received treatment with irbesartan, according to an economic analysis of the international Irbesartan Diabetic Nephropathy Trial (IDNT) presented today in Chicago.

"If patients with type 2 diabetes and kidney disease were treated with the angiotensin II receptor blocker irbesartan we could prevent, in the U.S. alone, about 35,000 cases of end-stage kidney disease at a cost savings of up to $2.3 billion over three years," said Edmund J. Lewis, M.D., director of nephrology at Rush-Presbyterian-St. Luke's Medical Center, Chicago and lead investigator of IDNT. "From a health economic perspective this is obviously good news. More importantly, though, irbesartan provides patients with the best standard of care and may, over time, extend their lives by seven to nine months."

The projected long-term economic benefits of irbesartan treatment relate to the drug's ability to slow the progression of late stage kidney disease or kidney failure in patients with type 2 diabetes. In the IDNT study, irbesartan reduced the risk of doubling of the serum (blood) creatinine or end-stage renal disease by 33 percent (p=0.003) versus placebo, and by 37 percent (p<0.001) versus amlodopine (a calcium channel blocker). The IDNT study also demonstrated that irbesartan significantly reduced the risk of progression of kidney disease or death by 23 percent compared to those treated with amlodipine (p=0.006) and by 20 percent compared to those receiving a placebo (p=0.02). This means that even patients taking irbesartan, who progressed to kidney failure, progressed more slowly, on average taking one year longer before needing dialysis.

From a health economic perspective, irbesartan use among patients with type 2 diabetes and kidney disease may potentially result in approximate gains of seven to nine months of life at a health care cost savings per patient of $13,000 to $23,000 after 25 years. When extrapolated to the estimated U.S. population of such patients, the potential net savings could reach between $7 and $13 billion dollars. Irbesartan may also help prevent the need for dialysis or kidney transplantation, which currently costs approximately $50,000 per U.S. patient annually. Without dialysis or transplantation, nearly 70,000 Americans would die from kidney disease each year.

The American Diabetes Association (ADA), taking into account the results of clinical trials such as IDNT, issued guidelines in January 2002 that recommend angiotensin II receptor blockers, such as irbesartan, as the agent of choice in the treatment of patients with type 2 diabetes and evidence of kidney disease. The U.S. Food and Drug Administration approved the use of irbesartan for the treatment of diabetic nephropathy in September 2002.

Earlier this year (June) the European Commission also approved the use of irbesartan for the treatment of both early and late stage diabetic renal disease in hypertensive type 2 diabetic patients. IDNT cost effectiveness models, developed using country-specific costs from France and Belgium, also showed that irbesartan led to improved life expectancy and total lifetime cost savings. Costs saved ranged from approximately Euro 12,000 per patient ($12,000) to Euro 23,000 ($23,000) per patient depending on the country and comparator.

"Whether the analyses were conducted in the U.S. or Europe, they show that treating eligible patients, early, with irbesartan equates to financial savings and increased life expectancy for patients," said Roger Rodby, M.D., associate professor, Section of Nephrology at Rush-Presbyterian-St. Luke's Medical Center, Chicago.

Hypertension affects more than 600 million people worldwide and hypertension-associated diseases such as cardiovascular disease and diabetic kidney disease are the leading cause of death in the developed world. Patients with type 2 diabetes have nearly a 50 percent risk of having diabetic kidney disease, which is associated with an almost inevitable progression to kidney failure. About 12.5 million Americans suffer from chronic kidney failure and more than 424,000 have developed end-stage kidney disease (End Stage Renal Disease or ESRD). Men, the elderly and members of the Native American, African American and Asian/Pacific Islander population groups are at greatest risk of developing ESRD.

This event is not part of the official Scientific Sessions 2002 as planned by the American Heart Association Committee on Scientific Sessions Program. IDNT was supported by an educational grant from Bristol-Myers Squibb and Sanofi-Synthelabo.

Source: Rush-Presbyterian-St. Luke’s Medical Center