Cost-effectiveness of angiotensin-converting enzyme inhibitors in nondiabetic advanced renal disease.

BACKGROUND National and international clinical guidelines do not consistently recommend treating nondiabetic proteinuric patients with advanced renal disease with an angiotensin-converting enzyme (ACE) inhibitor. OBJECTIVE To determine the cost-effectiveness of ACE inhibitor therapy in nondiabetic proteinuric patients with advanced renal disease in Germany. METHODS Two strategies were compared: treating patients with advanced renal disease with an ACE inhibitor and no ACE inhibitor treatment. A lifetime Markov decision model was developed using published data on costs and health outcomes and simulated the progression of renal disease with costs and benefits discounted at 3%. A statutory health insurance perspective was adopted. RESULTS In the base-case analysis, ACE inhibitor treatment is associated with lower costs and higher benefit and therefore dominates the no-treatment strategy. A probabilistic sensitivity analysis demonstrates that the probability of savings is 80%. CONCLUSION ACE inhibitor treatment for nondiabetic patients with advanced renal disease is highly cost effective.