OBJECTIVES: To project the cumulative incidence (CI) of end-stage renal disease (ESRD), life expectancy (LE) and costs of treating patients with diabetes, hypertension, and microalbuminuria with either standard hypertension treatment alone (control) or standard hypertension treatment plus irbesartan 300 mg daily in Spanish, Swedish, and Swiss settings. METHODS: A peer-reviewed, published Markov/Monte Carlo model simulated progression from microalbuminuria to nephropathy, doubling of serum creatinine, ESRD, and all-cause mortality in patients with hypertension, type-2 diabetes and microalbuminuria was adapted to Spanish, Swedish, and Swiss settings using country-specific costs and ESRD outcomes data. CI of ESRD, costs and LE were projected for a hypothetical cohort of 1000 subjects. Future costs and LE were discounted at recommended country-specific rates. A 25-year time horizon and third party payer perspective were used. Sensitivity analysis was performed. RESULTS: When compared to standard blood pressure control, irbesartan was projected to reduce the CI of ESRD from (mean±standard deviation) 24±1% to 9±2%, save 11,082€±2,996€, SEK 124,018±31,000 and CHF 18,057±4’646 in the Spanish, Swedish and Swiss settings respectively, and add 1.40±0.27, 1.49±0.27 and 1.41±0.28 life years per treated patient in the Spanish, Swedish and Swiss settings respectively. Costs of dialysis and renal transplantation were the major cost drivers. The advantages associated with irbesartan over standard care was robust under a wide range of plausible assumptions. CONCLUSIONS: Treating patients with hypertension, microalbuminuria and type-2 diabetes with irbesartan was projected to reduce the incidence of ESRD, extend life and reduce costs in all 3 countries analysed.