PharmacoEconomics - Italian Research Articles 7 (1): 43-57, 2005 1590-9158/05/0007-0043/$31.00/0 © 2005 Adis Data Information BV.Tutti i diritti riservati. Costo-efficacia di irbesartan in pazienti con diabete di tipo 2, ipertensione e nefropatia: prospettiva italiana A.J. Palmer, 1 L. Annemans, 2,3 S. Roze, 1 M. Lamotte, 2 P. Berto, 4 M. Ravera, 5 R.A. Rodby 6 1 CORE - Center for Outcomes Research, Basel, Svizzera 2 HEDM - Health Economics and Disease Management, Meise, Belgio 3 Ghent University, Ghent, Belgio 4 pbe consulting, Verona 5 Nefrologia, Dipartimento di Medicina Interna, Università di Genova, Genova 6 Section of Nephrology, Rush-Presbyterian St. Luke’s Medical Center, Chicago, USA Cost-effectiveness analysis of irbesartan in patients with type 2 diabetes, hypertension and nephropathy: the Italian perspective Background: The Irbesartan in Diabetic Nephropathy Trial (IDNT) demonstrated that treatment with irbesartan reduced progression to a combined endpoint of doubling of serum creatinine (DSC), end-stage renal disease (ESRD), or death compared to standard blood pressure control or amlodipine treatment. An epidemiological model was developed to project long term health effects and cost consequences of the IDNT in an Italian setting. Methods: A Markov model was constructed considering four possible disease states: overt nephropathy, DSC, ESRD, and death. Treatment-specific transition probabilities between states were derived from the IDNT. Data for Italy relating to the management and outcome of ESRD were retrieved from local sources. Outcomes for the three arms (irbesartan, amlodipine, placebo control [standard hypertension treatment alone − excluding angiotensin converting enzyme inhibitors, other angiotensin-2-receptor antagonists and dihydropyridine calcium channel blockers]) were expressed in terms of cumulative incidence (CI) of ESRD onset, life expectancy and costs over a 10 year time horizon. Future costs and life expectancy were discounted at 5% per annum. Extensive sensitivity analyses were performed. Results: The 10-year cumulative incidences of ESRD were 36%, 49%, and 45% with irbesartan, amlodipine, and control treatment arms respectively. Projected 10 year gains in discounted life expectancy due to ESRD avoided were 0.10 years and 0.22 years versus amlodipine and control respectively. Irbesartan led to 10-year net cost savings of € 13,530 and € 8,133/patient versus amlodipine and control respectively. The results were robust under a wide range of plausible assumptions. Conclusions: Treating type 2 diabetes patients with hypertension, and overt nephropathy using irbesartan was both cost- and life-saving compared to amlodipine and standard blood pressure treatment in an Italian setting. Summary