Kiberd BA, Jindal KK
Routine treatment of insulin dependent diabetic (IDDM) paients
with angiotensin-converting enzyme inhibitors to prevent renal
failure: an economic evaluation
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1360 1996
The high prevalence of other conditions that justify the use of ACEi in
patients with diabetes calls into the question the necessity of screening
patients for microalbuminuria to "justify" treatment with ACEi.
The authors "test" three strategies for treating patients after their fifth
year of IDDM by computer model for the cost effectiveness. The outcome was
the cost of a quality adjusted life year added.
A) Screen and treat according to existing guideline (AJKD
25:107,1995)
B) Treat everyone with IDDM after 5 years with ACEi
C) Treat only "high risk" (poor control, family history of BP, smoker)
Strategies B and C were superior to A. Sensitivity analysis showed no
change in conclusions allowing for different effectiveness of ACEi,
different drug costs, or differing ratio of high to low risk patients.
Comment: This hypothesis is intuitively reasonable. Practically,
the cost of the
screening makes sense only in normotensive patients without heart failure
for whom cost and side effects of the medication would have to be
justified.
(Peter B. DeOreo MD, Case Western Reserve University, Cleveland)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
H: Pathophysiology :
Kidney in hypertension
H: Drug therapy :
ACE inhibitors