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Cost-Effectiveness of Aliskiren in Type 2 Diabetes, Hypertension, and Albuminuria

Thomas E. Delea^*, Oleg Sofrygin^*, James L. Palmer, Helen Lau, Veronica C. Munk, Jennifer Sung, Alan Charney^||, Hans-Henrik Parving^¶ and Sean D. Sullivan^**

*PAI (Policy Analysis, Inc.), Brookline, Massachusetts;
IMS Health, Basel, Switzerland;
Evidence Based Medicine and
^||US Medical, Cardiovascular and Metabolism, Novartis Pharmaceuticals Corp., East Hanover, New Jersey;
Global Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Switzerland;
^¶Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
**Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington

Correspondence: Mr. Thomas E. Delea, MSIA, Senior Research Consultant, PAI (Policy Analysis Inc.), Four Davis Court, Brookline, MA 02445. Phone: 617-232-4400; Fax: 617-232-1155; E-mail: tdelea{at}pai2.com

Received for publication November 4, 2008. Accepted for publication June 15, 2009.

The Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) trial demonstrated that adding aliskiren, an oral direct renin inhibitor, at a dosage of 300 mg/d to the highest approved dosage of losartan and optimal antihypertensive therapy reduces albuminuria over 6 mo among patients with type 2 diabetes, hypertension, and albuminuria. The cost-effectiveness of this therapy, however, is unknown. Here, we used a Markov model to project progression to ESRD, life years, quality-adjusted life years, and lifetime costs for aliskiren plus losartan versus losartan. We used data from the AVOID study and the Irbesartan in Diabetic Nephropathy Trial (IDNT) to estimate probabilities of progression of renal disease. We estimated probabilities of mortality for ESRD and other comorbidities using data from the US Renal Data System, US Vital Statistics, and published studies. We based pharmacy costs on wholesale acquisition costs and based costs of ESRD and transplantation on data from the US Renal Data System. We found that adding aliskiren to losartan increased time free of ESRD, life expectancy, and quality-adjusted life expectancy by 0.1772, 0.1021, and 0.0967 yr, respectively. Total expected lifetime health care costs increased by $2952, reflecting the higher pharmacy costs of aliskiren and losartan ($7769), which were partially offset by savings in costs of ESRD ($4860). We estimated the cost-effectiveness of aliskiren to be $30,500 per quality-adjusted life year gained. In conclusion, adding aliskiren to losartan and optimal therapy in patients with type 2 diabetes, hypertension, and albuminuria may be cost-effective from a US health care system perspective.

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J. Am. Soc. Nephrol. 2009 20: A12. [Full Text] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673