Cost-Effectiveness Analysis of Renin-Angiotensin Aldosterone System Blockade in Progression of Chronic Kidney Disease



To assess the cost effectiveness of renin-angiotensin aldosterone system (RAAS) blockade in the progression of chronic kidney disease using Thai clinical data in 2014.


A Markov model for cost-effectiveness analysis was applied to estimate from a societal perspective the cost per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio of RAAS versus non-RAAS used in preventing the progression of end-stage renal disease and death stratified by diabetic and nondiabetic patients. Input parameters related to clinical outcomes were obtained from a cohort study of treatment effectiveness, whereas costs were retrieved from the Ramathibodi Hospital electronic database in 2015 and the Health Intervention and Technology Assessment Program in Thailand. One-way analysis and probabilistic sensitivity analysis were performed to evaluate uncertainty surrounding model parameters.


From the model, using RAAS improved QALY from 2.41 to 3.16 years and from 2.37 to 3.20 years in diabetic and nondiabetic groups, respectively. The incremental cost-effectiveness ratios for these groups were 78,250 baht (US $2,353.39) and 66,674 baht (US $2,005.22), respectively.


Using RAAS in patients with chronic kidney disease improved QALY in both diabetic and nondiabetic patients and proved to be cost-effective.


Oraluck Pattanaprateep Atiporn Ingsathit Mark McEvoy John Attia Ammarin Thakkinstian

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