OBJECTIVES: Type-2 diabetes patients with hypertension have a high risk of developing nephropathy, with increased risks of morbidity/mortality. Screening for, and treatment of nephropathy, is currently suboptimal in France. We assessed the long-term impact of screening for nephropathy followed by optimal antihypertensive therapy in those in which nephropathy is detected in France. METHODS: A Markov model projected lifetime impacts of screening, identification, and appropriate treatment of nephropathy using semi-quantitative urine dipsticks in a primary care setting, followed by treatment with irbesartan 300 mg added to conventional antihypertensives in a typical cohort of hypertensive type 2 diabetes patients. The model simulated progression from no renal disease to end-stage renal disease (ESRD). Probabilities and costs came from published sources. Cumulative incidence of ESRD, years free of ESRD, life expectancy (LE) and direct costs were projected. Second-order Monte Carlo simulation was used to account for uncertainty in multiple parameters. RESULTS: In a cohort of 1000 patients, screening for nephropathy followed by optimal treatment reduced cumulative incidence of ESRD from (mean ± SD) 11.0 ± 1.7% to 6.5 ± 1.1%, increased number of ESRD-free years by 524 ± 80 years, increased undiscounted LE by 361 ± 60 years, and reduced costs (discounted 3% annually) by €3,340,200 ± 799,800. Sensitivity analysis showed that screening was most beneficial in younger patients. CONCLUSIONS: In hypertensive type-2 diabetes patients, screening for albuminuria followed by optimal antihypertensive treatment that includes irbesartan 300 mg, is projected to lead to substantial reductions in the incidence of ESRD, improvements in ESRD-free survival and life expectancy, and overall cost savings.