Cost Effectiveness of ACE Inhibitor Treatment for Patients with Type 1 Diabetes Mellitus

Dong, Frederick B.; Sorensen, Stephen W.; Manninen, Diane L.; Thompson, Theodore; Narayan, Venkat; Orians, Carlyn E.; Gregg, Edward W.; Eastman, Richard C.; Dasbach, Erik J.; Herman, William H.; Newman, Jeffrey; Narva, Andrew S.; Ballard, David J.; Engelgau, Michael M.

doi:10.2165/00019053-200422150-00005

Cited by 16 publications

(7 citation statements)

References 33 publications

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“…A first, obvious one is full disclosure of the authors’ conflicts of interest in the acknowledgements to articles, an issue that has been amply debated (3;10;13). Even so, we still found some worrying examples in our review: thirteen articles did not report any acknowledgement at all; and two, co-signed by employees of pharmaceutical companies, actually denied any conflict of interest (6;8). We believe that international journals should strengthen their checks on competing interests of sponsored economic evaluations based on modeling, because these exercises are so open to discretionary assumptions.…”

Section: Discussionmentioning

confidence: 92%

Modeling in pharmacoeconomic studies: Funding sources and outcomes

Garattini¹,

Koleva²,

Casadei³

2010

Int J Technol Assess Health Care

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Section: Discussionmentioning

confidence: 92%

Modeling in pharmacoeconomic studies: Funding sources and outcomes

Garattini¹,

Koleva²,

Casadei³

2010

Int J Technol Assess Health Care

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“…Table 1 shows the detailed description of the CE studies that we included according to intervention type (13–70). We first grouped similar interventions together, then arranged them chronologically and by the first author's last name.…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

et al. 2010

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OBJECTIVETo synthesize the cost-effectiveness (CE) of interventions to prevent and control diabetes, its complications, and comorbidities.RESEARCH DESIGN AND METHODSWe conducted a systematic review of literature on the CE of diabetes interventions recommended by the American Diabetes Association (ADA) and published between January 1985 and May 2008. We categorized the strength of evidence about the CE of an intervention as strong, supportive, or uncertain. CEs were classified as cost saving (more health benefit at a lower cost), very cost-effective (≤$25,000 per life year gained [LYG] or quality-adjusted life year [QALY]), cost-effective ($25,001 to $50,000 per LYG or QALY), marginally cost-effective ($50,001 to $100,000 per LYG or QALY), or not cost-effective (>$100,000 per LYG or QALY). The CE classification of an intervention was reported separately by country setting (U.S. or other developed countries) if CE varied by where the intervention was implemented. Costs were measured in 2007 U.S. dollars.RESULTSFifty-six studies from 20 countries met the inclusion criteria. A large majority of the ADA recommended interventions are cost-effective. We found strong evidence to classify the following interventions as cost saving or very cost-effective: (I) Cost saving— 1) ACE inhibitor (ACEI) therapy for intensive hypertension control compared with standard hypertension control; 2) ACEI or angiotensin receptor blocker (ARB) therapy to prevent end-stage renal disease (ESRD) compared with no ACEI or ARB treatment; 3) early irbesartan therapy (at the microalbuminuria stage) to prevent ESRD compared with later treatment (at the macroalbuminuria stage); 4) comprehensive foot care to prevent ulcers compared with usual care; 5) multi-component interventions for diabetic risk factor control and early detection of complications compared with conventional insulin therapy for persons with type 1 diabetes; and 6) multi-component interventions for diabetic risk factor control and early detection of complications compared with standard glycemic control for persons with type 2 diabetes. (II) Very cost-effective— 1) intensive lifestyle interventions to prevent type 2 diabetes among persons with impaired glucose tolerance compared with standard lifestyle recommendations; 2) universal opportunistic screening for undiagnosed type 2 diabetes in African Americans between 45 and 54 years old; 3) intensive glycemic control as implemented in the UK Prospective Diabetes Study in persons with newly diagnosed type 2 diabetes compared with conventional glycemic control; 4) statin therapy for secondary prevention of cardiovascular disease compared with no statin therapy; 5) counseling and treatment for smoking cessation compared with no counseling and treatment; 6) annual screening for diabetic retinopathy and ensuing treatment in persons with type 1 diabetes compared with no screening; 7) annual screening for diabetic retinopathy and ensuing treatment in persons with type 2 diabetes compared with no screening; and 8) immediate vitrectomy to treat ...

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“…Activation of NFKB1 by angiotensin II was shown in vascular smooth muscle and mesangial cells (Hernández-Presa et al, 1997 ). In a study by Dong et al analyzing cost effectiveness of ACE inhibitor treatment for patients with type 1 diabetes mellitus the level of glycosylated HbA1c showed clear impact on cost effectiveness of drug use per quality-adjusted life year (QALY) (Dong et al, 2004 ). The authors concluded that next to patient age also other factors need to be included in therapy considerations.…”

Section: Discussionmentioning

confidence: 99%

From molecular signatures to predictive biomarkers: modeling disease pathophysiology and drug mechanism of action

Heinzel

Perco

Mayer

et al. 2014

Front. Cell Dev. Biol.

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Omics profiling significantly expanded the molecular landscape describing clinical phenotypes. Association analysis resulted in first diagnostic and prognostic biomarker signatures entering clinical utility. However, utilizing Omics for deepening our understanding of disease pathophysiology, and further including specific interference with drug mechanism of action on a molecular process level still sees limited added value in the clinical setting. We exemplify a computational workflow for expanding from statistics-based association analysis toward deriving molecular pathway and process models for characterizing phenotypes and drug mechanism of action. Interference analysis on the molecular model level allows identification of predictive biomarker candidates for testing drug response. We discuss this strategy on diabetic nephropathy (DN), a complex clinical phenotype triggered by diabetes and presenting with renal as well as cardiovascular endpoints. A molecular pathway map indicates involvement of multiple molecular mechanisms, and selected biomarker candidates reported as associated with disease progression are identified for specific molecular processes. Selective interference of drug mechanism of action and disease-associated processes is identified for drug classes in clinical use, in turn providing precision medicine hypotheses utilizing predictive biomarkers.

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Cost Effectiveness of ACE Inhibitor Treatment for Patients with Type 1 Diabetes Mellitus

Cited by 16 publications

References 33 publications

Modeling in pharmacoeconomic studies: Funding sources and outcomes

Modeling in pharmacoeconomic studies: Funding sources and outcomes

Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review

From molecular signatures to predictive biomarkers: modeling disease pathophysiology and drug mechanism of action

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