Boersma Cornelis, Atthobari Jarir, Gansevoort Ron T, de Jong-Van den Berg Lolkje T W, de Jong Paul E, de Zeeuw Dick, Annemans Lieven J P, Postma Maarten J
Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration (GUIDE), Groningen, The Netherlands.
Pharmacoeconomics. 2006;24(6):523-35. doi: 10.2165/00019053-200624060-00001.
Angiotensin II receptor antagonists (angiotensin II receptor blockers; ARBs) are a class of antihypertensive drugs that are generally considered comparable to ACE inhibitors in the prevention of heart and kidney failure. However, these two classes of agents do interfere in different stages of the renin-angiotensin system. In patients with type 2 diabetes mellitus, advantages for ARBs over conventional (non-ACE inhibitor) therapy on progression from micro- to macroalbuminuria and overt nephropathy and end-stage renal disease have been shown in clinical trials. In patients with type 2 diabetes and end-stage renal disease, the need for dialysis and/or transplantation results in the use of major healthcare resources. This paper reviews the available economic evidence on treatment with ARBs in type 2 diabetic patients with advanced renal disease.Within-trial analytic and Markov model economic evaluations of the RENAAL (Reduction of Endpoint in Non-insulin dependent diabetes mellitus with Angiotensin II Antagonist Losartan), IDNT (Irbesartan Diabetic Nephropathy Trial) and IRMA (IRbesartan in type 2 diabetes with MicroAlbuminuria)-2 studies suggest that treatment with ARBs in patients with type 2 diabetes with overt or incipient nephropathy confers health gains and net cost savings compared with conventional (non-ACE inhibitor) therapy. For reimbursement and reference pricing decisions, there is a need for a head-to-head comparison of an ACE inhibitor with ARBs to model all possible costs and effects of ACE inhibitors and ARBs. This will result in a proper pharmacoeconomic outcome, where both types of drugs can be compared for healthcare decisions.
血管紧张素 II 受体拮抗剂（血管紧张素 II 受体阻滞剂；ARB）是一类抗高血压药物，一般认为在预防心力衰竭和肾衰竭方面与 ACE 抑制剂相当。然而，这两类药物在肾素 - 血管紧张素系统的不同阶段发挥作用。在 2 型糖尿病患者中，临床试验已表明 ARB 相对于传统（非 ACE 抑制剂）疗法在从微量白蛋白尿进展至大量白蛋白尿、显性肾病和终末期肾病方面具有优势。在 2 型糖尿病和终末期肾病患者中，透析和/或移植的需求导致大量医疗资源的使用。本文综述了有关 ARB 治疗 2 型糖尿病晚期肾病的现有经济学证据。对 RENAAL（用血管紧张素 II 拮抗剂氯沙坦降低非胰岛素依赖型糖尿病终点事件）、IDNT（厄贝沙坦糖尿病肾病试验）和 IRMA（2 型糖尿病微量白蛋白尿患者使用厄贝沙坦）-2 研究的试验内分析和马尔可夫模型经济学评估表明，与传统（非 ACE 抑制剂）疗法相比，ARB 治疗显性或早期肾病的 2 型糖尿病患者可带来健康获益和净成本节约。为了进行报销和参考定价决策，需要将 ACE 抑制剂与 ARB 进行直接比较，以模拟 ACE 抑制剂和 ARB 的所有可能成本和效果。这将产生一个合适的药物经济学结果，从而可以对这两种药物进行比较以做出医疗决策。
