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

Charles Christian Adarkwah; Afschin Gandjour

Disclosures

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

In This Article

Results

In the base-case analysis, which had a lifetime horizon, the ACE inhibitor treatment strategy dominated the no-treatment strategy (Table 3). Treatment was therefore associated with lower costs and a larger health benefit. Shorter term simulations over 3 and 10 years demonstrated the same finding, that is, lower costs and a larger benefit.

Sensitivity Analysis

In the univariate sensitivity analysis, variables with the largest impact on incremental costs and effectiveness are the effectiveness of ACE inhibitor treatment, the discount rate of costs and effects, and the cost of ESRD (Table 4). A threshold sensitivity analysis shows that at an ACE inhibitor cost of €5325 per year (base case: €130.58) the break-even point is reached. The break-even point indicates where the costs of treatment exactly equal the costs of no treatment.

Figure 2 demonstrates the cost–effectiveness acceptability curve, which considers uncertainty in cost–effectiveness. Replications with lower effectiveness of the ACE inhibitor treatment strategy compared with the no-treatment strategy (19%) were categorized as not cost effective (regardless of concurrent savings) as it would be unethical to accept treatment that is less effective than no treatment. Hence, the maximum probability of cost–effectiveness independent of the willingness to pay is 80%. The probability of savings is also 80%. A scatter plot is presented in Figure 3.

Figure 2.

Cost–effectiveness acceptability curve.

Figure 3.

Cost–effectiveness plane showing 1000 replications from a distribution of cost and quality-adjusted life year differences (angiotensin-converting enzyme inhibitor vs no treatment).
QALY: Quality-adjusted life year.

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