Le Pen C, Petitjean P, Lévy P, Hannedouche T
LEGOS, Université Paris-Dauphine, Strasbourg.
Nephrologie. 1996;17(6):321-6.
A controlled, double-blind trial, carried out by Lewis and al., has shown that in 409 patients presenting with insulin-dependent diabetes, proteinuria in excess of 500 mg/day and plasma creatinine of less than 221 mumol/l, captopril treatment was able to reduce the risk of combined events (mortality, renal dialysis and transplantation) by 50% (p = 0.006) and that of doubling plasma creatinine by 48% (p = 0.007). We evaluated the cost/benefit ratio of this treatment on the basis of the medical outcome of this study and economic data for the French health-care system. The cost of the treatment by captopril is totally offset by the reduction in costs obtained by postponing dialysis and kidney transplantation, concomitant antihypertensive treatment and hospitalisation. In this study, the health expenditure savings in the captopril group amounted to 6 million French Francs. Spending 100.-Francs on captopril to treat diabetic nephropathy yielded savings of 575.-Francs. This economic advantage, plus a reduction of 6 in the number of deaths, corresponding to 131 life-years saved, demonstrates the favorable cost-benefit ratio of this treatment strategy.
刘易斯等人进行的一项对照双盲试验表明，在409例胰岛素依赖型糖尿病患者中，若蛋白尿超过500毫克/天且血浆肌酐低于221微摩尔/升，卡托普利治疗能够将联合事件（死亡率、肾透析和移植）的风险降低50%（p = 0.006），并将血浆肌酐翻倍的风险降低48%（p = 0.007）。我们根据这项研究的医学结果以及法国医疗保健系统的经济数据评估了这种治疗的成本效益比。卡托普利治疗的成本完全被推迟透析和肾脏移植、同时进行的抗高血压治疗以及住院所带来的成本降低所抵消。在这项研究中，卡托普利组节省的医疗支出达600万法国法郎。花费100法郎用卡托普利治疗糖尿病肾病可节省575法郎。这种经济优势，再加上死亡人数减少6例，相当于挽救了131个生命年，证明了这种治疗策略具有良好的成本效益比。
