A health economic analysis of screening and optimal treatment of nephropathy in patients with type 2 diabetes and hypertension in the USA

Palmer, Andrew J.; Valentine, William J.; Chen, Roland; Mehin, N; Gabriel, Sylvie; Bregman, Bruno; Rodby, Roger A.

doi:10.1093/ndt/gfn082

Cited by 65 publications

(60 citation statements)

References 35 publications

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“…Two sensitive input parameters in one-way sensitivity analysis showed positive predictive value and the cost of tests. Results different from those of Palmer et al in that sensitivity analysis showed benefits of cost and outcomes of the screening in type 2 diabetes with hypertension; especially in patients at the age of 40 years [31][32]. On the other hand, Kiberd et al [35] reported that annual costs of ESRD were moderately sensitive to the model, whereas screening and drug cost had little effect.…”

Section: Discussionmentioning

confidence: 76%

“…The costeffectiveness was found only in high-risk groups with hypertension and proteinuria [30]. Palmer et al reported that screening for microalbuminuria and overt nephropathy in diabetic patients with hypertension and use of renoprotective agents was cost-effective in the USA and France [31][32]. Proteinuria screening in subjects without diabetes or hypertension for early treatment with ACEI to delay progression of nephropathy was not cost-effective, except in highrisk groups such as the elderly, hypertensives, and diabetic patients [33][34].…”

Section: Discussionmentioning

confidence: 99%

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Original article. Cost-effectiveness of annual microalbuminuria screening in Thai diabetics

et al. 2014

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Background: Diabetes is a leading cause of end stage renal disease (ESRD), which impacts on treatment costs and patients' quality of life. Microalbuminuria screening in patients with diabetes as an early intervention is beneficial in slowing the progression of diabetic nephropathy. Objectives: We aimed to assess the cost-effectiveness of annual microalbuminuria screening in type 2 diabetic patients. Methods: We compared screening by urine dipsticks with a "do nothing" scenario. To replicate the natural history of diabetic nephropathy, a Markov model based on a simulated cohort of 10,000 45-year-old normotensive diabetic patients was utilized. We calculated the cost and quality of life gathered from a cross-sectional survey. The costs of dialysis were derived from The National Health Security Office (NHSO). We also calculated the incremental cost-effectiveness ratio (ICER) for lifetime with a future discount rate of 3%. Results: The ICER was 3,035 THB per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses showed that all ICERs were less than the Thai Gross Domestic Product (GDP) per capita (150,000 THB in 2011) based on World Health Organization's suggested criteria. Conclusions: Annual microalbuminuria screening using urine dipsticks in type 2 diabetic patients is very costeffective in Thailand based on World Health Organization's recommendations. This finding has corroborated the benefit of this screening in the public health benefit package.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Original article. Cost-effectiveness of annual microalbuminuria screening in Thai diabetics

et al. 2014

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“…Health economic analyses have shown that screening for albuminuria in the Type 2 diabetic patients and subsequent initiation of angiotensin II antagonists treatment in those found positive contributed to better outcomes, including reduction of cardiovascular event, and may represent an excellent value. 31,32 On the other hand, some have argued that simply treating all middle-aged diabetic patients with angiotensinconverting enzyme inhibitors is a simple strategy that provides additional benefit at modest additional cost. 33 For the general population, a strategy of annual dipstick screening for gross proteinuria with follow-up testing and treatment with an angiotensin-converting enzyme inhibitor may not be cost-effective with regard to slowing progression of kidney disease or decreasing mortality.…”

Section: Lee Et Al Microalbuminuria and Stroke: Meta-analysis 2627mentioning

confidence: 99%

Impact of Microalbuminuria on Incident Stroke

Lee

Saver²,

Chang³

et al. 2010

Stroke

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Background and Purpose-Microalbuminuria, a marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and magnitude of the link between microalbuminuria and incident stroke has not been clearly defined. The purpose of this study was to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective studies using meta-analysis. Methods-We conducted a systematic search of electronic databases and bibliographies for studies reporting a multivariate-adjusted estimate, represented as relative risk with 95% CI, of the association between microalbuminuria and stroke risk. Studies were excluded if a majority of study participants had established kidney disease or pre-eclampsia. Estimates were combined using a random-effect model. Results-We identified 12 studies, with a total of 48 596 participants and 1263 stroke events. Overall, presence of microalbuminuria was associated with greater stroke risk (relative risk, 1.92; 95% CI, 1.61 to 2.28; PϽ0.001) after adjustment for established cardiovascular risk factors. There was evidence of significant heterogeneity in the magnitude of the association across studies (P for heterogeneity Ͻ0.001, I

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“…As DN progresses, there is an increase in urinary albumin excretion, observed as microalbuminuria and progressing to macroalbuminuria (4,5). Furthermore, after onset of DN, about 20% of individuals will progress to endstage renal diseases (ESRD) (6,7).…”

Section: Introductionmentioning

confidence: 99%

Effect of Type 2 Diabetes Mellitus and Diabetic Nephropathy on IgG Pharmacokinetics and Subcutaneous Bioavailability in the Rat

Chadha

Morris

2015

AAPS J

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Abstract. The objective of this research was to assess the effects of type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) on the pharmacokinetics of human IgG (hIgG), an antibody isotype, in Zucker diabetic fatty (ZDF) rats. Furthermore, the specific role of T2DM in the altered disposition of hIgG was evaluated by treating diabetic rats with pioglitazone, while the role of chronic kidney disease (CKD) was assessed using 5/6 nephrectomized Sprague Dawley rats. ZDF male (lean non-diabetic control and obese diabetic) and pioglitazone-treated ZDF rats were studied at ages 12-13 weeks (only DM was present), and at ages 29-30 weeks (progression to DN). All animals were dosed with 1 mg/kg of hIgG intravenously (IV) or subcutaneously (SC). ZDF rats had significantly higher blood glucose concentrations and urinary albumin excretion compared to control rats. Significant increases in total clearance (2.5-fold) and renal clearance (100-fold) of hIgG were observed; however the major increase in total clearance was due to increased non-renal clearance. Greater changes in urinary albumin excretion and total and renal clearances of IgG (3.5-fold and 300-fold, respectively) were observed with progression to DN. SC bioavailability of hIgG in all animal groups was similar (>84%). With pioglitazone-treatment, diabetic animals remained euglycemic and treatment was able to reverse the clearance changes, although incompletely. In the CKD group, no difference in hIgG clearance was observed when compared with controls. In conclusion, the increased clearance of hIgG in ZDF diabetic animals, reversal by pioglitazone treatment and lack of effect of CKD, demonstrate the influence of T2DM on hIgG pharmacokinetics.

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A health economic analysis of screening and optimal treatment of nephropathy in patients with type 2 diabetes and hypertension in the USA

Abstract: In patients with type 2 diabetes and hypertension, screening for nephropathy and treatment with a renoprotective-based antihypertensive agent was projected to improve patient outcomes and represent excellent value in a US setting.

Cited by 65 publications

References 35 publications

Original article. Cost-effectiveness of annual microalbuminuria screening in Thai diabetics

Original article. Cost-effectiveness of annual microalbuminuria screening in Thai diabetics

Impact of Microalbuminuria on Incident Stroke

Effect of Type 2 Diabetes Mellitus and Diabetic Nephropathy on IgG Pharmacokinetics and Subcutaneous Bioavailability in the Rat

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