Abstract
Hyperphosphatemia management is integral to the management of patients with chronic kidney disease. This mineral abnormality is associated with greater costs, but so is its management, especially with the use novel phosphate binders. The economic evaluation of these pharmaceutical agents is increasingly needed to provide evidence for value of money spent and inform resource allocation. Recently, Nguyen et al. explored the economical attractiveness of Sevelamer relative to Calcium Carbonate among patients with chronic kidney disease not yet on dialysis and concluded that the former was cost-effective. The current commentary discusses the results of this analysis and sheds light on the methodological challenges of economic evaluations in this field.
Highlights
The cost-effectiveness of phosphate binders was first addressed among hemodialysis patients, where due to many factors, the management of serum phosphorus is a continuous challenge
Hyperphosphatemia is consistently and independently associated with increased morbidity and mortality among end stage renal disease patients [1,2,3], and results in financial burdens for health systems [4]. This issue was explored to a lesser extent among patients with chronic kidney disease (CKD), results from large studies suggest an independent association between elevated serum phosphorus levels and increased patient mortality risk [5, 6]
Serum phosphorus management in CKD patients has gained increasing importance in contemporary nephrology practice, and tight targets for serum phosphorus levels were set for these patients, up-till-we still lack conclusive evidence, ie prospective interventional studies, to Correspondence: r.rizk@maastrichtuniversity.nl Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands demonstrate that reduction in serum phosphate improves CKD patient outcomes
Summary
Concerns about the high cost of hyperphosphatemia’s consequences are offset by concerns about hyperphosphatemia’s high treatment cost [8], especially with the novel pharmaceuticals, ie non-calcium-based phosphate binders. Economic evaluations -studies providing evidence for value of money spent- are being increasingly used by public health decision makers to guide the allocation of scarce resources [9]
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