Abstract
AIMSIn Spain, the first line treatment of hyperphosphatemia in Chronic Kidney Disease (CKD) consists of calcium-based phosphate binders (CB). However, their use is associated with vascular calcification and an increased mortality risk. The aim of this study was to assess the incremental cost-effectiveness of second-line Lanthanum Carbonate (LC) treatment in patients not responding to CB (calcium carbonate and calcium acetate).Material and methodsA lifetime Markov model was developed considering three health states (predialysis, dialysis and death). Transitions between states and efficacy data were obtained from randomized clinical trials and the European Dialysis and Transplant Association Annual report. Mortality rate was adjusted with the relative risk related to serum phosphorus levels.According to the Spanish healthcare system perspective, only medical direct costs were considered. Dialysis costs (2013 prices in Euros) were obtained from diagnosis-related groups. Drug costs were derived from ex-factory prices, adjusted with 7.5% mandatory rebate. Quality of life estimates were based on a published systematic review. Costs and benefits were discounted at 3%. Deterministic and probabilistic sensitivity analyses (PSA) were conducted.ResultsAt the end of simulation, costs per patient with LC therapy were €1,169 and €5,044 with CB alone. 4.653 Quality Adjusted Life Years (QALYs) were gained per patient treated with LC, and 4.579 QALYs with CB. CB therapy is dominated by the LC strategy (i.e. lower costs, higher QALYs). Assuming a €30,000/QALY threshold, LC was dominant in 100% of PSA simulations.ConclusionsLC is a cost-effective second line treatment of hyperphosphatemia in CKD patients irrespective of dialysis status in Spain.
Highlights
Chronic kidney disease (CKD) causes changes in calcium and phosphorus metabolism leading on hyperphosphatemia and hypercalcemia
At the end of simulation, costs per patient with Lanthanum Carbonate (LC) therapy were €1,169 and €5,044 with calcium-based phosphate binders (CB) alone. 4.653 Quality Adjusted Life Years (QALYs) were gained per patient treated with LC, and 4.579 QALYs with CB
CB therapy is dominated by the LC strategy
Summary
Chronic kidney disease (CKD) causes changes in calcium and phosphorus metabolism leading on hyperphosphatemia and hypercalcemia. During the last decade it has been demonstrated that elevated serum phosphorus (SP) and calcium levels may cause extraskeletal calcification of the tunica media in the vasculature of CKD patients [1]. These calcifications result in cardiovascular disease which is the leading cause of morbidity and mortality in patients with CKD [2]. Treatment guidelines from the Kidney Disease Outcomes Quality Initiative (K/DOQI) recommend that serum target levels be maintained between 3.5 and 5.5 mg/dL [3]. It has been demonstrated that treatment with CB along with decreased of renal excretory capacity in CKD patients may accelerate the vascular calcification and increase cardiovascular mortality in the long term due to the
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