Cost-effectiveness of screening for albuminuria with subsequent fosinopril treatment to prevent cardiovascular events: A pharmacoeconomic analysis linked to the prevention of renal and vascular endstage disease (PREVEND) study and the prevention of renal and vascular endstage disease intervention trial (PREVEND IT)

Principles of Screening for Chronic Kidney Disease

“…Among 864 people, cardiovascular events occurred in 45 (5.2%), and people who received fosinopril had a 40% lower incidence of cardiovascular events compared with people who received placebo. The cost-effectiveness of screening for albuminuria in the general Dutch population was determined to be 16,700 Euro per life-year gained (59).…”

“…To achieve this, 1000 people would need to have a 24-h urine test for protein (700 of which would have false-positive results) and 100 people would need to be treated with ACEI for 2 to 3 yr (60). More recently, in the Netherlands, Atthobari et al (59) reported on the cost-effectiveness of screening for albuminuria with subsequent treatment with fosinopril to prevent cardiovascular events using data from a single-center, double-blind, randomized, placebo-controlled trial within the larger observational study Prevention of Renal and Vascular Endstage Disease (PREVEND). Among 864 people, cardiovascular events occurred in 45 (5.2%), and people who received fosinopril had a 40% lower incidence of cardiovascular events compared with people who received placebo.…”

Cost-Effectiveness Analysis of a Randomized Trial Comparing Care Models for Chronic Kidney Disease

“…In addition to clinical underutilization, there is also uncertainty with respect to whether there are additional costs or savings when implementing early intervention programs (11)(12)(13)(14). One study looked at stage 4 CKD patients who were under the care of a nephrologist (12), but this study involved later stage CKD with creatinine clearance of 20 ml/min or lower.…”

“…However, neither of these studies included costs for cardiovascular outcomes, and each was based on cohort studies or literature evidence (11). A subsequent cost-effectiveness analysis based on a trial of early screening for albuminuria included patients with normal BP and cholesterol levels (14). In this analysis, patients with al-buminuria were treated with an angiotensin-converting enzymes inhibitor and this was cost-effective to prevent cardiovascular events.…”

World Kidney Day 2011: Protect your kidneys, save your heart

“…PREVEND IT reported a 44% (not significant) reduction in CV events over 4 years in patients screened from a general population with no risk factors except increased albumin in the urine who were treated with renaltargeted ACEI therapy [30]. This effect was seen primarily in people with albumin excretion rates of >50 mg/day in a pilot study, and the intervention was shown to be cost-effective in that population [31]. CV endpoints were significantly reduced in direct proportion to the reduction of albuminuria with ACEI therapy, and albuminuria proved to be the only predictor of CV outcome [32].…”