Cost–Effectiveness of Angiotensin-converting Enzyme Inhibitors in Nondiabetic Advanced Renal Disease

Charles Christian Adarkwah; Afschin Gandjour


Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(2):215-223. 

In This Article


As stated, the analysis was conducted from the perspective of the German SHI. Hence, only direct costs were considered. Costs were inflated to year 2009 euros using data on the consumer price index.[101] Costs of ACE inhibitors and treatment of ESRD, as well as healthcare expenditures related and unrelated to CKD, were taken into account. For ACE inhibitor therapy we used the reference price of benazepril, 10 mg twice a day.[102] We included costs of ACE inhibitor therapy for patients who had to be excluded in the 8-week run-in period as these patients would be treated in the real world. In a sensitivity analysis, we applied the price of the cheapest generic of enalapril 5 mg once daily as used in the RCT by Ihle et al..[14]

For patients with advanced chronic renal insufficiency, we included age-specific healthcare expenditures unrelated to CKD,[103] as well as related healthcare expenditures.[26,103,104] To determine the latter, we applied unit costs[27] to resource consumption based on international recommendations for the treatment of CKD.[28–30] Annual costs of patients with ESRD were calculated as a weighted average of the costs of dialysis and renal transplantation.[3,31] Prevalence data served as weights.[2] In Germany, 73% of patients with ESRD undergo dialysis. Annual costs of transplantation were calculated as an average of initial treatment and follow-up costs.[31] As approximately 3% of transplant patients experience failure and thus need to return to dialysis, they incur initial transplantation costs.[2] These costs were included in the analysis. Costs and benefits were discounted at an annual rate of 3%.[15]


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