Cost-effectiveness of ACE inhibitor therapy to prevent dialysis in nondiabetic nephropathy: influence of the ACE insertion/deletion polymorphism. Export

@article{citeulike:5845524, abstract = {INTRODUCTION: End-stage renal disease is associated with high health-care costs and low quality of life compared with chronic kidney disease. The renoprotective effectiveness of angiotensin-converting enzyme inhibitors (ACEi) is largely determined by the ACE insertion/deletion (I/D) polymorphism. We determined the cost-effectiveness of ACEi therapy in nondiabetic nephropathy for the ACE II/ID and for the ACE DD genotype separately. Furthermore, we considered a selective screen-and-treat strategy in which patients are prescribed alternative, more effective, therapy based on their ACE (I/D) polymorphism. METHODS: Time-dependent Markov models were constructed; cohorts of 1000 patients were followed for 10 years. Data were mainly gathered from the Ramipril Efficacy In Nephropathy trial. Both univariate and probabilistic sensitivity analyses were performed. RESULTS: ACEi therapy dominated placebo in both the ACE II/ID group (euro15 826, and 0.091 quality-adjusted life years gained per patient) and the ACE DD group (euro105 104 and 0.553 quality-adjusted life years gained). Sensitivity analyses showed 30.2\% probability of ACEi being not cost-effective in the ACE II/ID group, against an almost 100\% probability of cost-effectiveness in the ACE DD group. A selective screen-and-treat strategy should incorporate an alternative therapy for patients with the ACE II/ID genotype with an at least 9.1\% increase in survival time compared with ACEi therapy to be cost-effective. Sensitivity analyses show that higher effectiveness and lower costs of the alternative therapy improve the cost-effectiveness of a screening strategy. CONCLUSION: ACEi therapy is a cost-saving treatment compared with placebo in nondiabetic nephropathy, irrespective of ACE (I/D) genotype. However, ACEi therapy saved more costs and more health gains were achieved in the ACE DD genotype than in the ACE II/ID genotype. An alternative treatment featuring a modest increase in effectiveness compared with ACEi therapy for patients with the ACE II/ID genotype can be incorporated in a cost-effective or even cost-saving screen-and-treat strategy.}, author = {Vegter, Stefan and Perna, Annalisa and Hiddema, W\^{a}tse and Ruggenenti, Piero and Remuzzi, Giuseppe and Navis, Gerjan and Postma, Maarten J.}, citeulike-article-id = {5845524}, citeulike-linkout-0 = {http://dx.doi.org/10.1097/FPC.0b013e3283307ca0}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19696696}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19696696}, doi = {10.1097/FPC.0b013e3283307ca0}, issn = {1744-6872}, journal = {Pharmacogenetics and genomics}, keywords = {ace, cea, dn, snp}, month = {September}, number = {9}, pages = {695--703}, posted-at = {2009-09-27 16:26:02}, priority = {2}, title = {Cost-effectiveness of ACE inhibitor therapy to prevent dialysis in nondiabetic nephropathy: influence of the ACE insertion/deletion polymorphism.}, url = {http://dx.doi.org/10.1097/FPC.0b013e3283307ca0}, volume = {19}, year = {2009} }

TY - JOUR ID - citeulike:5845524 L3 - citeulike-article-id:5845524 N2 - INTRODUCTION: End-stage renal disease is associated with high health-care costs and low quality of life compared with chronic kidney disease. The renoprotective effectiveness of angiotensin-converting enzyme inhibitors (ACEi) is largely determined by the ACE insertion/deletion (I/D) polymorphism. We determined the cost-effectiveness of ACEi therapy in nondiabetic nephropathy for the ACE II/ID and for the ACE DD genotype separately. Furthermore, we considered a selective screen-and-treat strategy in which patients are prescribed alternative, more effective, therapy based on their ACE (I/D) polymorphism. METHODS: Time-dependent Markov models were constructed; cohorts of 1000 patients were followed for 10 years. Data were mainly gathered from the Ramipril Efficacy In Nephropathy trial. Both univariate and probabilistic sensitivity analyses were performed. RESULTS: ACEi therapy dominated placebo in both the ACE II/ID group (euro15 826, and 0.091 quality-adjusted life years gained per patient) and the ACE DD group (euro105 104 and 0.553 quality-adjusted life years gained). Sensitivity analyses showed 30.2% probability of ACEi being not cost-effective in the ACE II/ID group, against an almost 100% probability of cost-effectiveness in the ACE DD group. A selective screen-and-treat strategy should incorporate an alternative therapy for patients with the ACE II/ID genotype with an at least 9.1% increase in survival time compared with ACEi therapy to be cost-effective. Sensitivity analyses show that higher effectiveness and lower costs of the alternative therapy improve the cost-effectiveness of a screening strategy. CONCLUSION: ACEi therapy is a cost-saving treatment compared with placebo in nondiabetic nephropathy, irrespective of ACE (I/D) genotype. However, ACEi therapy saved more costs and more health gains were achieved in the ACE DD genotype than in the ACE II/ID genotype. An alternative treatment featuring a modest increase in effectiveness compared with ACEi therapy for patients with the ACE II/ID genotype can be incorporated in a cost-effective or even cost-saving screen-and-treat strategy. IS - 9 JF - Pharmacogenetics and genomics SN - 1744-6872 EP - 703 TI - Cost-effectiveness of ACE inhibitor therapy to prevent dialysis in nondiabetic nephropathy: influence of the ACE insertion/deletion polymorphism. VL - 19 SP - 695 KW - ace KW - cea KW - dn KW - snp AU - Vegter, Stefan AU - Perna, Annalisa AU - Hiddema, Wâtse AU - Ruggenenti, Piero AU - Remuzzi, Giuseppe AU - Navis, Gerjan AU - Postma, Maarten PY - 2009/09// UR - http://dx.doi.org/10.1097/FPC.0b013e3283307ca0 ER -