PUK11 COST EFFECTIVENESS OF PHARMACEUTICAL TREATMENT OF HYPERPHOSPHATEMIA WITH PHOSPHATE BINDERS: A SYSTEMATIC REVIEW

Abstract

Hyperphosphatemia is associated with morbidity and mortality in end-stage renal disease (ESRD) patients. Phosphate binders (PBs) are the primary therapeutic treatment for hyperphosphatemia in ESRD patients receiving dialysis. Calcium-based binders are associated with an increased morbidity and mortality risk. Medicare spending on PBs has been estimated to be over $1.5 billion. The purpose of this study was to review economic evaluations of PBs to better understand their value. We conducted a systematic literature review of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar using the search terms “phosphate binder”, “hyperphosphatemia”, “ESRD”, “cost”, and “economic”. Results: were limited to recent economic evaluations published in English in peer reviewed journals between January 2015 and December 2019. Studies included in the review reported cost-effectiveness outcomes. Our search initially identified 84 publications. After removing irrelevant articles and duplicates, 5 publications met our inclusion criteria and were included in our review. Four of the five studies compared either sevelamer carbonate (SEV) or lanthanum carbonate (LC) to calcium-based binders. These analyses found SEV or LC to be cost-effective compared to calcium-based binders. A fifth study evaluated the cost effectiveness of two non-calcium-based phosphate binders, sucroferric oxyhydroxide (SO) and SEV, and found SO to be cost effective relative to SEV. This review demonstrates the need for more high-quality economic evaluations of phosphate binders. The use of calcium-based binders as a comparator group is sub-optimal given the risk they may pose to patients. Only one study, which found sucroferric oxyhydroxide to be cost-effective, was found that compared non-calcium-based binders.