Performance Improvement 2001. Assess Programs to Prevent Diabetic End-Stage Renal Disease


Diabetic end-stage renal disease (ESRD) is a serious and costly complication of diabetes. Renal protective benefits have been demonstrated for angiotensin converting enzyme (ACE) inhibitors, leaning the American Diabetes Association (ADA) to recommend that patients receive treatment with ACE inhibitors after the onset of microalbuminuria. The primary objective of this study was to evaluate the economic benefits of early, widespread treatment with ACE inhibitors for patients with Type 1 diabetes using a computer simulation model. The model developed for the study was based on the natural history of Type 1 diabetes. The model parameters were based on the findings from the major population surveys, clinical trials, and other clinical studies of individuals with diabetes as reported in the medical literature. The results show that the cost-effectiveness estimate from the base case analysis is at the high end of the acceptable range to support the strategy of early treatment with ACE inhibitors. The results also show that when good glycemic control is achieved and ACE treatment begins after onset of microalbuminuria, the lifetime incidence of diabetic ESRD is reduced from over 20% to a rate of under 2%. In addition, the estimated benefits of early ACE treatment are higher for patients who have an earlier age at onset for diabetes. This would suggest that children should be treated with ACE.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health


FEDERAL CONTACT: Stephen W. Sorenson, 770-488-1271

PIC ID: 7388

PERFORMER: Battelle Memorial Institute, Centers for Public Health Researchand Evaluation, Rockville, MD