ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2000
To pay or not to pay? A decision and cost-utility analysis of angiotensin-converting-enzyme inhibitor therapy for diabetic nephropathy.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Economic Modelling of Chronic Kidney Disease: A Systematic Literature Review to Inform Conceptual Model Design.PharmacoEconomics · 2019Pooled it
- Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review.Diabetes care · 2010Pooled it
- A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy.PharmacoEconomics · 2011Review
- The chronic kidney disease model: a general purpose model of disease progression and treatment.BMC medical informatics and decision making · 2011Article
- Health economics: the start of clinical freedom.BMC health services research · 2010Article
- The economic consequences of noncompliance in cardiovascular disease and related conditions: a literature review.International journal of clinical practice · 2008Review
- Cost-effective strategies in the prevention of diabetic nephropathy.PharmacoEconomics · 2004Review
- Managing hypertension in patients with renal disease and diabetes.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Managing hypertension in patients with renal disease and diabetes.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Access to the morning-after pill in BC.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Access to the morning-after pill in BC.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Patient compliance with drug therapy for diabetic nephropathy.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAngiotensin-converting-enzyme (ACE) inhibitor therapy can significantly delay the progression of diabetic nephropathy to end-stage renal failure (ESRF). The main obstacle to successful compliance with this therapy is the cost to the patients. The authors performed a cost-utility analysis from the government's perspective to see whether the province or territory should pay for ACE inhibitors for type I diabetic nephropathy on the assumption that cost is a major barrier to compliance with this important therapy.
methodsA decision analysis tree was created to demonstrate the progression of type I diabetes with macroproteinuria from the point of prescription of ACE inhibitor therapy through to ESRF management, with a 21-year follow-up. Drug compliance, cost of ESRF treatment, utilities and survival data were taken from Canadian sources and used in the cost-utility analysis. One-way and two-way sensitivity analyses were performed to test the robustness of the findings.
resultsCompared with a no-payment strategy, provincial payment of ACE inhibitor therapy was found to be highly cost-effective: it resulted in an increase of 0.147 in the number of quality-adjusted life-years (QALYs) and an annual cost savings of $849 per patient. The sensitivity analyses indicated that the cost-effectiveness depends on compliance, effect of benefit and the cost of drug therapy. Changes in the compliance rate from 67% to 51% could result in a swing in cost-effectiveness from a savings of $899 to an expenditure of more than $1 million per additional QALY. A 50% reduction in the cost of ACE inhibitors would result in a cost savings of $299 per additional QALY with compliance rates as low as 58% in the provincial payment strategy.
interpretationProvincial coverage of ACE inhibitor therapy for type I diabetes with macroproteinuria improves patient outcomes, with a decrease in cost for ESRF services.
Indexed as
Identifiers
10674051PMC1232268W2169939593What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.