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PubMed1998

In search of an animal model for postmenopausal diseases.

The purpose of this review is to discuss the use of the aged ovariectomized ewe as a cost-effective large animal model to study coronary artery disease (CAD), osteoporosis, osteoarthritis (OA), and oral bone loss--conditions seen after menopause. Earlier studies from our laboratory showed a significant decline in the bone mineral density (BMD) of the iliac crest following ovariectomy in sheep, while subsequent studies demonstrated decreased bone loss (measured by dual energy X-ray absorptiometry (DXA)) in the lumbar vertebrae following ovariectomy. We examined the effects of estrogen deficiency and estrogen therapy on the terminal aorta of the aged ovariectomized (OVX) ewes and demonstrated subintimal thickening in the distal aorta of animals that were estrogen deficient when compared to the control groups. A popular model to study OA is the knee joint of sheep following medial or lateral meniscus removal combined with exercise, but there is a need for an estrogen-deficient large animal model of OA to study articular cartilage changes occurring after menopause. We saw an effect of ovariectomy on the biomechanical properties (aggregate modulus and shear modulus) of articular cartilage. Estrogen deficiency had a detrimental effect on the articular cartilage of the knee even though the cartilage of the OVX animals appeared grossly normal. In another study, 13.5 months following ovariectomy, we found an increase in estrogen receptor binding capacity of the articular cartilage suggesting that articular cartilage is a sex-hormone sensitive tissue. There is intense interest in the correlation between systemic osteoporosis and bone loss of the mandible and maxilla. We studied mandibular bone loss in OVX sheep using DXA. The mean BMD of the OVX group versus sham and estradiol-treated animals was lower, indicating that systemic bone loss in OVX ewes may be accompanied by oral bone loss. Coronary artery disease, osteoporosis, osteoarthritis (OA) and oral bone loss all have a major impact on women's heath after menopause and we found that certain characteristics of these conditions can be reproduced in the skeletally mature or aged estrogen-deficient sheep. It is premature to promote the sheep as the only model to study estrogen deficiency and the many differences from small animal omnivores and non-human primates need to be overcome and a search for more economical models must continue. This model, however, may offer the opportunity to study postmenopausal conditions and the safety and efficacy of new therapeutic agents.

Animals↗
PubMed1999

Epidemiology and cost analysis of varicella in Italy: results of a sentinel study in the pediatric practice. Italian Sentinel Group on Pediatric Infectious Diseases.

BACKGROUND: Describing the epidemiology of varicella is relevant to the development of specific prevention strategies and to building up of economic models evaluating the cost:efficiency ratios of these strategies. AIM: Our study was designed to describe the epidemiology of chickenpox among Italian children and to assess the resulting economic and health burden on the country. METHODS: Thirty-nine Italian pediatricians participated in a sentinel network on pediatric infectious diseases representing a total pediatric population of 30 168 children. Each case of varicella observed from January through December, 1997, was recorded. Economic analysis was conducted from the societal point of view. All costs were broken down into two groups: direct and indirect costs. RESULTS: A total of 1599 cases of varicella were reported among children 0 to 14 years old. There were 1266 primary cases (mean age, 4.5 +/- 2 years) and 333 secondary cases (mean age, 3.6 +/- 3.2 years). The global incidence of chickenpox was 51.01/1000/year. Complications were seen in 56 cases (3.5%). Drugs were prescribed in 672 cases. A group of adults (364 susceptible and 193 with uncertain status) were exposed to primary cases. Seventy (12.5%) were eventually infected among whom there were 4 pregnant women. For pediatric patients an average cost of $146.90 (250 400 lire) was estimated; this is largely accounted for by indirect costs. CONCLUSIONS: The epidemiology of varicella in Italy is consistent with that found in previous studies in industrialized countries. Severe complications did not occur in our population. We believe that the health arguments in favor of universal vaccination of children > 18 months of age do not differ in our own country from those of other industrialized nations. Our data could now be incorporated into pharmacoeconomic models to establish cost-efficient strategies for Italy.

Adolescent↗
PubMed2026

Health-system burden of higher-risk myelodysplastic syndromes in England: a literature-based micro-cost analysis.

OBJECTIVES: To quantify the per-patient-per-month (PPPM) cost for each phase of care in higher-risk myelodysplastic syndromes (HR-MDS) and the overall cost of a base-case (illustrative) non-curative management pathway followed by a patient with HR-MDS in England. DESIGN: We conducted a retrospective, literature-based, micro-costing analysis from the National Health Service (NHS) England provider perspective using published sources and publicly available price lists. No individual-patient data were used. Based on literature, a base-case management pathway followed by a patient with HR-MDS was defined as a diagnostic work-up at month 0, 12 cycles of azacitidine (given for 7 days in each 28-day cycle), 5 months of post-hypomethylating agent (HMA) failure supportive care and 1 month of terminal care. SETTING: Healthcare resource utilisation was analysed for adults with HR-MDS who received first-line azacitidine in routine practice if cycle-level or phase-level transfusion and admission rates were reported in the literature. Patients who required allogeneic haematopoietic stem cell transplantation or whose HR-MDS transformed to acute myeloid leukaemia were excluded because the diagnostic and/or therapeutic pathways differ. Unit costs for 2024/2025 were taken from published English national sources and an English trust tariff. RESULTS: PPPM costs were £8721.58 during active azacitidine therapy, £5399.58 after HMA failure and £12 554.58 for hospital-dominant terminal care; a one-off diagnostic work-up with genomics cost £2710 to £2810. The total cost for the base-case management pathway was £146 921 per patient. An alternative pathway excluding genomic testing and assuming hospice-dominant terminal care reduced the total cost to approximately £136 840 to £140 990, depending on whether the lower or upper bound of hospice bed-day costs is applied. CONCLUSIONS: The direct NHS-provider cost burden of this non-curative HR-MDS management pathway is concentrated in azacitidine acquisition and administration during active treatment, transfusions and admissions after HMA failure and setting-dependent costs at the end of life. The total cost for the illustrative management pathway followed by a patient with HR-MDS (£146 921) is of a similar order to the estimate in the National Institute for Health and Care Excellence technology appraisal for azacitidine uprated to £124 848 for 2024/2025. This comparison is provided for context only and should not be interpreted as validation of the present model, given differences in population, model structure, treatment duration and price year. The phase-specific PPPM estimates can inform, subject to local validation and scenario testing, UK budget-impact analyses, service planning and future economic models.

Humans↗
PubMed1997

A framework for the economic evaluation of telemedicine.

This paper describes the economic issues associated with the introduction of telemedicine systems and the main challenges to their evaluation. An approach to the economic evaluation of telemedicine is described based on a cost-consequence framework. The paper links these costs and consequences more formally within a set of evaluative questions which in turn forms the basis for an economic model for evaluating telemedicine. By outlining the key questions, a number of issues relevant to the evaluation of telemedicine are identified and considered. The main challenges to the economic evaluation of telemedicine include: constantly changing technology; lack of appropriate study design to manage the frequently inadequate sample sizes; inappropriateness of the conventional techniques of economic evaluation; and the valuation of health and non-health outcomes. The present study addresses these challenges and suggests ways of advancing the techniques for the economic evaluation of telemedicine.

Capital Expenditures↗
PubMed1983

Expected relative responses to selection for alternative measures of life cycle economic efficiency of pork production.

Relative genetic responses to selection for alternative measures of economic efficiency of pork production were examined. The analysis was based on results from a deterministic bio-economic model of lifecycle pork production. Alternative aggregate breeding values considered were based on cost (+)/unit of live weight or of carcass output lean for different production systems and for different breeding roles of the selected stocks. For cost/unit of lean, changes in leanness (or fatness) dominated the index. For cost/unit of live weight, however, no one trait dominated the index, and changes in growth and reproductive traits as well as the breeding role of the stock (purebred, maternal or paternal) were important in defining selection objectives. Management and production systems were less important than breeding role for cost/unit live weight output, except that importance of growth rate was increased by marketing at the mean weight reached at a fixed age rather than at a fixed weight irrespective of age. Implications of these results for goals and systems of pig improvement are discussed.

Adipose Tissue↗
PubMed2006

[The cost of complications: implications for the measurement of the cost of type II diabetes mellitus].

BACKGROUND: A well-known methodology used to compute the macroeconomic cost of risk factors is the etiologic cost ratio, leading to estimates based on data on the prevalence of the risk factor in the general population, the relative risk of complications associated to it and the cost of the complications. A major problem of this method is that it is in some extent inconsistent with recent findings showing an increase in the per capita cost of some complications in presence of type II diabetes mellitus. The aim of the paper is to reconcile the approach with most recent economic studies and to overview the consequences of such an attempt in terms of methodological framework. METHODS: We developed a methodological framework introducing heterogeneity in the cost of treating complications according to the presence of diabetes. We estimated the macroeconomic cost of type II diabetes mellitus based on selected complications (stroke, myocardial infarction, nephropathy and peripheral arterial obstructive disease) from French representative data in two situations: a situation in which the heterogeneity is not taken into account, another situation in which heterogeneity is introduced. RESULTS: Our results point out that the assumption of homogeneity in the cost of complications is associated to an underestimation of the cost of diabetes by about 30%. CONCLUSION: Our results present an attempt to reconcile the economic modeling of the cost of type II diabetes mellitus with the "real world". We conclude that the introduction of heterogeneity is necessary to capture the whole extent of the economic burden of the disease and that it places significant constraints on the data and the methodological framework to be used in such attempts.

Costs and Cost Analysis↗
PubMed1999

Economic implications of pain management.

BACKGROUND: Economic issues in pain management affect the patient, the provider and society. This paper will review some of the data on the costs to society of chronic pain and its associated disability. It will also look at the costs to patient and provider of alternative economic models. Conceptual issues that underlie health care delivery and the attendant costs must be addressed if society is to gain control over runaway health care costs and reduce the economic burden of chronic pain and disability for the patient as well as the provider. METHODS: Literature review and synthesis. RESULTS: Chronic pain is the primary cause of health care consumption and disability in the working years. Multidisciplinary pain clinics have proven utility. Data on efficacy of most other kinds of care is lacking. Disability costs are related to conceptual inadequacies and the medicalization of post-industrial societies. CONCLUSION: To control inappropriate care and escalating costs, we must change concepts of pain and disability and the methods of funding both of these in relation to chronic pain. The outcome of the continuing struggle between the profession of medicine, the state and capitalists will determine how and whether pain management is a part of medical care.

Chronic Disease↗
PubMed2005

Economic burden of pertussis and the impact of immunization.

Although routine use of vaccines has diminished the incidence of pertussis disease, it has not eliminated the pathogen. Epidemiologic data confirm that pertussis remains a significant health problem in all age groups. Disease burden is highest in infants, in whom pertussis disease frequently leads to severe complications and mortality, although it is also a significant health burden in adolescents and adults, in whom the reported incidence of pertussis is increasing. The Global Pertussis Initiative reviewed the literature to find data that express the economic impact of this health burden and to review economic evaluations of pertussis immunization. Although only limited data on the direct and indirect costs of pertussis are available, they suggest that it poses a significant economic burden and indicate that the direct medical costs of pertussis depend on the rate of hospitalization and the severity of complications, and are highest in infants. The indirect costs of pertussis also appear to be considerable, particularly among adults, in whom the disease reduces work productivity, because of either personal illness or child care responsibilities. Several health economic models on the cost effectiveness of childhood immunization strategies have been published, and although constrained by missing data, have generally found childhood immunization strategies to be cost-effective. Economic analyses of adolescent and adult immunization strategies have also been conducted, but the findings of these studies have been inconsistent. The most recent evaluations, using much higher estimates of incidence than reported previously, suggest that immunization of adolescents and specific adult subgroups may be cost-effective. The literature review confirmed that the economic burden of pertussis is substantial, but there are gaps in existing information. In the short term, further economic analyses are required, particularly of adolescent and adult immunization. More importantly, collection of primary epidemiologic and economic data should be undertaken in parallel. Despite the existing gaps in data, further research using the most current data should facilitate decisions on new vaccination strategies by describing conditions for favorable results and quantifying the margin of uncertainty.

Adolescent↗
PubMed2003

The use of hepatitis a vaccination in Italy: an economic evaluation.

We report on the conduct and results of an economic model of two different strategies of vaccination against hepatitis A in Italy. In strategy 1 (universal vaccination), all newborns are vaccinated simultaneously with MMR at 15 months and all 12 year olds are vaccinated with combined hepatitis A and B vaccine. In strategy 2 (contacts' vaccination) only subjects with a close social and spatial relationship with the sick are vaccinated. In strategy 1 costs per avoided case and net costs per avoided case values are always very high. Net costs become very low when newborns and 12 year olds are vaccinated, and become negative (indicating a potential gain) when 12 year olds are vaccinated. From an economic viewpoint, universal vaccination appears recommendable only in epidemic conditions. For strategy 2 our model shows that cost for avoidable case are very low and net costs for avoided case are always negative, showing the potential presence of an absolute benefit. We conclude that in Italy mass vaccination appears economically worthwhile only during epidemics but vaccination of contacts is an economically worthwhile routine measure.

Costs and Cost Analysis↗
PubMed2004

Accounting- versus economic-based rates of return: implications for profitability measures in the pharmaceutical industry.

BACKGROUND: Accounting-based profits have indicated that pharmaceutical firms have achieved greater returns relative to other sectors. However, partially due to the theoretically inappropriate reporting of research and development (R&D) expenditures according to generally accepted accounting principles, evidence suggests that a substantial and upward bias is present in accounting-based rates of return for corporations with high levels of intangible assets. Given the intensity of R&D in pharmaceutical firms, accounting-based profit metrics in the drug sector may be affected to a greater extent than other industries. OBJECTIVE: The aim of this work was to address measurement issues associated with corporate performance and factors that contribute to the bias within accounting-based rates of return. METHODS: Seminal and broadly cited works on the subject of accounting- versus economic-based rates of return were reviewed from the economic and finance literature, with an emphasis placed on issues and scientific evidence directly related to the drug development process and pharmaceutical industry. RESULTS: With international convergence and harmonization of accounting standards being imminent, stricter adherence to theoretically sound economic principles is advocated, particularly those based on discounted cash-flow methods. Researchers, financial analysts, and policy makers must be cognizant of the biases and limitations present within numerous corporate performance measures. Furthermore, the development of more robust and valid economic models of the pharmaceutical industry is required to capture the unique dimensions of risk and return of the drug development process. CONCLUSIONS: Empiric work has illustrated that estimates of economic-based rates of return range from approximately 2 to approximately 11 percentage points below various accounting-based rates of return for drug companies. Because differences in the nature of risk and uncertainty borne by drug manufacturers versus other sectors make comparative assessments of performance challenging and often inappropriate, continued work in this area is warranted.

Accounting↗
PubMed2004

Economic analyses on the use of positron emission tomography for the work-up of solitary pulmonary nodules and for staging patients with non-small-cell-lung-cancer in Italy.

AIM: Increasing ageing of the population and tumor incidence, along with worldwide rationing of the resources for public health systems, spur the use of economic analyses for the choice of strategies and technologies in the assessment and management of cancer patients. Incidence and clinical managing of tumors vary in different countries even if positron emission tomography (PET) with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) is becoming a routine clinical method for diagnosis, staging, treatment monitoring and follow-up in a variety of tumors. Available data indicate that PET can be considered a superior alternative or complementary tool to other well-established methods. However, in spite of the above and of the rapidly increasing number of PET centers in Europe, USA and Japan, only a few studies have dealt with some of the economic aspects raised by the clinical use of PET because of differences in values of reimbursements and health costs. The main aim of this study is to propose and discuss an economic model of analysis for PET applications in the field of detection and management of pulmonary tumors. METHODS: In this study 2 assessments were performed by decision tree analysis on the economic impact of the availability of PET on decision-making processes for 2 conditions: solitary pulmonary nodules assessment and non-small-cell lung cancer (NSCLC) staging. In order to define a methodology consistent with the system of reimbursement and the prevalent clinical views of the Italian National Health Service, data on costs, death probability, and life expectancy were gathered from the literature and from the Italian system of reimbursement (ROD-DRGs). RESULTS: The results of the cost minimization analysis demonstrate that the use of PET in the diagnostic path for the workup of patients with SPN reduces the overall diagnostic costs, by approximately 50 Euro per patient, by reducing inappropriate invasive diagnostic investigation and their complications. The results of the cost effectiveness analysis demonstrate that the use of PET in the diagnostic path for the staging of patients with NSCLC reduces the overall diagnostic costs by approximately 108 Euro for added year, by reducing inappropriate surgical interventions and their complications. CONCLUSION: Both analyses are based on standard methods used in the literature, so our conclusions can be compared with results and assessments of similar studies in different countries and health care systems. Also in the Italian case, the use of an economic assessment provides relevant information on the efficacy and effectiveness of PET.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

Warfarin vs enoxaparin for deep venous thrombosis prophylaxis after total hip & total knee arthroplasty: a cost comparison.

BACKGROUND: Total joint replacements are high-risk procedures for development of deep venous thrombosis (DVT) and pulmonary embolism (PE), therefore, routine pharmacological prophylaxis should be instituted in all cases. Cost-containment has become an important factor with the present changes in health care. This report presents an economic model for DVT prophylaxis after total hip and total knee arthroplasty (THA & TKA) that approximates closely to the current standards in orthopedic practice, and encourages the balance of clinical and economic considerations in patient care management. METHODS: A simplified cost-effectiveness (cost-minimization) analysis, from the consumer's perspective, between Warfarin and Enoxaparin for DVT prophylaxis after THA and TKA, for a total of 15 days, in both inpatient and outpatient settings was used. The costs of drugs, laboratory, and home care services were evaluated through surveying three different providers in each category and obtaining the mean value for each of the services supplied. All providers were located within the Louisville, KY, metropolitan area. Data collection took place in October 1996. RESULTS: The main outcome measure was the difference in cost between the two drugs when all factors associated with therapy were considered. The overall cost of DVT prophylaxis with Enoxaparin was somewhat less expensive ($925.38) when compared to Warfarin ($971.77). CONCLUSIONS: Within the limitations of this study Enoxaparin was slightly more cost-effective than Warfarin for venous thromboembolism prophylaxis after total hip and knee arthroplasty.

Anticoagulants↗
PubMedDate not supplied

The impact of morbid obesity on the state economy: an initial evaluation.

BACKGROUND: Obesity's impact on a state's economy has not been fully analyzed. This study compared bariatric surgery demographics at a large university hospital to that of a broader region's population statistics. From this comparison, an economic model was derived that evaluated, for the state of New Mexico, the cost of obesity in terms of lost business output, employment, and income. METHODS: Between September 2003 and September 2005, we analyzed the charts of all of our patients from New Mexico who underwent laparoscopic gastric bypass and laparoscopic banding. Input-output analysis estimate margins, the purchase prices for goods and services, and regional purchase coefficients, the percent of spending by local suppliers, were used to model the regional economy. Collected patient data, used in conjunction with IMPLAN model data, were used to estimate, on a regional basis, an industry-by-industry formulation of input-output accounts to calculate multipliers in order to assess the impact of economic costs of the obese on the general economy. RESULTS: Total labor income impacts are nearly 200 million dollars, 1,660 dollars of output income per household and 245 dollars of labor income per household. Obesity cost New Mexico more than 7,300 jobs and cut state and local tax revenues by more than 48 million dollars. CONCLUSION: Obesity's impact of more than 1.3 billion dollars amounts to 2.5% of New Mexico's gross state product. Governmental measures to combat this menace are warranted.

Adult↗
PubMed1994

Remodeling health care.

Standard models of patient demand for health care and health care suppliers' response to that demand imply that some manner of manipulation of the prices faced by patients must be chief among the mechanisms of systemic cost control. However convenient econometrically, these standard models cannot reflect the complexity of patient demand behavior, and they say little about the predominant causes of health-care cost escalation. This paper describes a richer Jevonian political-economic model that sensibly portrays patient demand and physician and corporate supply behaviors and suggests a range of cost-controlling and care-enhancing compensatory steps, some professional, some societal. This new model implies that reformers in the United States could take respectful advantage of the fundamentally self-regulating nature of patient demand for health care by shifting their attention away from its further discouragement and toward the modulation of other factors.

Cost Sharing↗
PubMed1998

Reporting format for economic evaluation. Part II: Focus on modelling studies.

This article presents the first version of a reporting format for modelling studies which is based on a general reporting format by our taskforce, which was published in the previous issue of this journal. The use of decision-analytical models for economic evaluations is increasing because, in practice, it is not always possible to derive information from prospective studies. However, the acceptance of modelling studies is generally lower than prospective studies not only because of the use of secondary data, but also because the reports of modelling studies do not always have sufficient transparency. Hence, a standardised reporting format may improve the transparency and, consequently, the acceptance of modelling studies. This article presents an example of a reporting format for economic evaluation based on modelling studies, which may facilitate the development of future guidelines for modelling studies. The format consists of a number of headings, which are followed by a brief recommendation on the content. This format does not deal with methodology and data management, but especially addresses validation and quality assurance, which may increase the transparency of the report.

Decision Support Techniques↗
PubMed1980

Economic-demographic simulation models: a review of their usefulness for policy analysis.

"This paper assesses the usefulness of economic-demographic simulation models for policy analysis, emphasizing in particular the relevance of the current state of the art for agricultural development planners. A critical review of eight models defines the range of questions that can be answered with particular models, evaluating the reasonableness of their specifications and the probable quality of their performance. Suggestions concerning further research are also provided."

Agriculture↗
PubMed2005

Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation.

OBJECTIVES: To review the clinical evidence comparing immediate angioplasty with thrombolysis, and to consider whether it would be cost-effective. DATA SOURCES: Electronic databases. Experts in the field. REVIEW METHODS: For clinical effectiveness, a comprehensive review of randomised control trials (RCTs) was used for efficacy, and a selection of observational studies such as case series or audit data used for effectiveness in routine practice. RCTs of thrombolysis were used to assess the relative value of prehospital and hospital thrombolysis. Observational studies were used to assess the representativeness of patients in the RCTs, and to determine whether different groups have different capacity to benefit. Clinical effectiveness was synthesised through a narrative review with full tabulation of results of all included studies and a meta-analysis to provide a precise estimate of absolute clinical benefit. Consideration was given to the effect of the growing use of stents. The economic modelling adopted an NHS perspective to develop a decision-analytical model of cost-effectiveness focusing on opportunity costs over the short term (6 months). RESULTS: The results were consistent in showing an advantage of immediate angioplasty over hospital thrombolysis. The updated meta-analysis showed that mortality is reduced by about one-third, from 7.6% to 4.9% in the first 6 months, and by about the same in studies of up to 24 months. Reinfarction is reduced by over half, from 7.6% to 3.1%. Stroke is reduced by about two-thirds, from 2.3% with thrombolysis to 0.7% with percutaneous coronary intervention (PCI), with the difference being due to haemorrhagic stroke. The need for coronary artery bypass graft is reduced by about one-third, from 13.2% to 8.4%. Caution is needed in interpreting some of the older trials, as changes such as an increase in stenting and the use of the glycoprotein IIb/IIa inhibitors may improve the results of PCI. There is little evidence comparing prehospital thrombolysis with immediate PCI. Research on thrombolysis followed by PCI, known as 'facilitated PCI', is underway, but results are not yet available. Trials may be done in select centres and results may not be as good in lower volume centres, or out of normal working hours. In addition, much of the marginal mortality benefit of PCI over hospital thrombolysis may be lost if door-to-balloon time were more than an hour longer than door-to-needle time. Conversely, within the initial 6 hours, the later patients present, the greater the relative advantage of PCI. Results suggest that PCI is more cost-effective than thrombolysis, providing additional benefits in health status at some extra cost. In the longer term, the cost difference is expected to be reduced because of higher recurrence and reintervention rates among those who had thrombolysis. CONCLUSIONS: If both interventions were routinely available, the economic analysis favours PCI, given the assumptions of the model. However, very few units in England could offer a routine immediate PCI service at present, and there would be considerable resource implications of setting up such services. Without a detailed survey of existing provision, it is not possible to quantify the implications, but they include both capital and revenue: an increase in catheter laboratory provision and running costs. The greatest problem would be staffing, and that would take some years to resolve. A gradual incrementalist approach based on clinical networks, with transfer to centres able to offer PCI, may be used. In rural areas, one option may be to promote an increase in prehospital thrombolysis, with PCI for thrombolysis failures. There is a need for data on the long-term consequences of treatment, the quality of life of patients after treatment, and the effects of PCI following thrombolysis failure.

Angioplasty↗
PubMed1997

Modelling and costing the consequences of using an ACE inhibitor to slow the progression of renal failure in type I diabetic patients.

Antihypertensive drugs slow the progressive decline in renal function seen in patients with insulin-dependent diabetes and nephropathy. In a recent study, the ACE inhibitor captopril protected against this deterioration in renal function. We developed an economic model to analyse the cost impact of ACE inhibitor treatment on progression to endstage renal failure (ESRF) in diabetic patients over 4 years. Two scenarios were compared: one describing the progression of a cohort of 1000 patients receiving 25 mg captopril three times daily, and the other for an equivalent cohort without such prophylactic treatment. Previously published data were used to estimate the transition rates for each stage from the onset of renal failure until death. All direct costs were discounted by an annual rate of 6%, and were subjected to sensitivity analysis. The discounted cost saving of ACE inhibitor treatment for a cohort of 1000 patients was estimated as 0.95 million pounds over 4 years. Under sensitivity analysis, these results were very robust to variations in the costs of ESRF treatment. Prophylactic treatment with ACE inhibitors was predicted to provide substantial increases in life expectancy and reduction in the incidence of ESRF, while also providing significant economic savings.

Adolescent↗