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

Stefan Vegter, Annalisa Perna, Wĝtse Hiddema, Piero Ruggenenti, Giuseppe Remuzzi, Gerjan Navis, Maarten J. Postma

Research output: Contribution to journalArticle

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 (€15826, and 0.091 quality-adjusted life years gained per patient) and the ACE DD group (€105104 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% robability 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 lternative 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.

Original languageEnglish
Pages (from-to)695-703
Number of pages9
JournalPharmacogenetics and Genomics
Volume19
Issue number9
DOIs
Publication statusPublished - Sep 2009

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Keywords

  • Angiotensin-converting enzyme inhibitors
  • Chronic kidney failure
  • Cost-effectiveness analysis
  • End-stage renal disease
  • Genetic polymorphism

ASJC Scopus subject areas

  • Genetics
  • Molecular Biology
  • Molecular Medicine
  • Genetics(clinical)

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