TY - JOUR
T1 - Cost-effectiveness of screening for albuminuria with subsequent fosinopril treatment to prevent cardiovascular events
T2 - A pharmacoeconomic analysis linked to the prevention of REnal and vascular ENdstage disease (PREVEND) study and the prevention of REnal
AU - Atthobari, J.
AU - Asselbergs, F.W.
AU - Boersma, C.
AU - de Vries, R.
AU - Hillege, H.L.
AU - van Gilst, W.H.
AU - Gansevoort, R.T.
AU - de Jong, P.E.
AU - de Jong-van den Berg, L.T.W.
AU - Postma, M.J.
PY - 2006/3
Y1 - 2006/3
N2 - Objective: This study estimated the cost-effectiveness, from the Dutch health care perspective, of screening for albuminuria in the general Dutch population to prevent cardiovascular events (CVEs) with subsequent angiotensin-converting enzyme inhibitor treatment, using data from the Prevention of REnal and Vascular ENdstage Disease Intervention Trial (PREVEND IT).Methods: PREVEND IT was a single-center, double-blind, randomized, placebo-controlled trial with a 2 X 2 factorial design within the larger observational Prevention of REnal and Vascular ENdstage Disease (PREVEND) study. The PREVEND IT study was conducted to assess the effects of fosinopril 20 mg and pravastatin 40 mg on CVEs in subjects with specific inclusion criteria: urinary albumin excretion (UAE) rate in the range from 15 to 300 mg/d, blood pressure <160/100 mm Hg, and plasma cholesterol level <8.0 mmol/L. Cost-effectiveness estimates for the Dutch population were expressed in euros (2002; 1EURO = US $1.01.) as net costs per life-year gained (LYG) in the baseline and sensitivity (stochastic) analyses.Results: Data were assessed for 864 subjects, with a mean (SD) follow-up of 46 (7) months. CVEs occurred in 45 (5.2%) subjects. Subjects who received fosinopril had a 40% lower incidence of CVEs than subjects in the placebo group (3.9% vs 6.5%, respectively; P = NS). The cost-effectiveness of screening for albuminuria was determined to be EURO16,700/LYG for the study population. Stochastic analysis indicated that the probability of the cost-effectiveness being below the suggested Dutch threshold of EURO20,000/LYG was 59% in the baseline analysis. The probability of cost-effectiveness below EURO20,000/LYG would increase to 91% if only subjects with UAE > 50 mg/d were treated with fosinopril. Limiting the screening to subjects aged > 50 years and > 60 years also improved cost-effectiveness.Conclusions: The results of our study suggest that screening the general Dutch population for albuminuria and Subsequently treating those found positive with fosinopril may be cost-effective compared with no screening and adopting the Dutch health care perspective. However, confirmation from larger multi-center trials is needed.
AB - Objective: This study estimated the cost-effectiveness, from the Dutch health care perspective, of screening for albuminuria in the general Dutch population to prevent cardiovascular events (CVEs) with subsequent angiotensin-converting enzyme inhibitor treatment, using data from the Prevention of REnal and Vascular ENdstage Disease Intervention Trial (PREVEND IT).Methods: PREVEND IT was a single-center, double-blind, randomized, placebo-controlled trial with a 2 X 2 factorial design within the larger observational Prevention of REnal and Vascular ENdstage Disease (PREVEND) study. The PREVEND IT study was conducted to assess the effects of fosinopril 20 mg and pravastatin 40 mg on CVEs in subjects with specific inclusion criteria: urinary albumin excretion (UAE) rate in the range from 15 to 300 mg/d, blood pressure <160/100 mm Hg, and plasma cholesterol level <8.0 mmol/L. Cost-effectiveness estimates for the Dutch population were expressed in euros (2002; 1EURO = US $1.01.) as net costs per life-year gained (LYG) in the baseline and sensitivity (stochastic) analyses.Results: Data were assessed for 864 subjects, with a mean (SD) follow-up of 46 (7) months. CVEs occurred in 45 (5.2%) subjects. Subjects who received fosinopril had a 40% lower incidence of CVEs than subjects in the placebo group (3.9% vs 6.5%, respectively; P = NS). The cost-effectiveness of screening for albuminuria was determined to be EURO16,700/LYG for the study population. Stochastic analysis indicated that the probability of the cost-effectiveness being below the suggested Dutch threshold of EURO20,000/LYG was 59% in the baseline analysis. The probability of cost-effectiveness below EURO20,000/LYG would increase to 91% if only subjects with UAE > 50 mg/d were treated with fosinopril. Limiting the screening to subjects aged > 50 years and > 60 years also improved cost-effectiveness.Conclusions: The results of our study suggest that screening the general Dutch population for albuminuria and Subsequently treating those found positive with fosinopril may be cost-effective compared with no screening and adopting the Dutch health care perspective. However, confirmation from larger multi-center trials is needed.
KW - cost-effectiveness analysis
KW - fosinopril
KW - urinary albumin excretion
KW - cardiovascular disease
KW - CONVERTING ENZYME-INHIBITORS
KW - HEART-FAILURE
KW - HYPERTENSIVE PATIENTS
KW - GENERAL-POPULATION
KW - ACE-INHIBITORS
KW - RISK-FACTORS
KW - MICROALBUMINURIA
KW - RAMIPRIL
KW - MORTALITY
KW - INDIVIDUALS
U2 - 10.1016/j.clinthera.2006.03.012
DO - 10.1016/j.clinthera.2006.03.012
M3 - Article
VL - 28
SP - 432
EP - 444
JO - Clinical Therapeutics
JF - Clinical Therapeutics
SN - 0149-2918
IS - 3
ER -