Abstract | OBJECTIVES: METHODS: Long-term cardiovascular implications of 1 year of treatment with phosphate binders in patients on hemodialysis are estimated based on the patient's demographics, comorbidities, and physiologic and renal parameters. The initial calcification score and expected changes over 1 year are derived using regression equations developed from the Treat-to-Goal study and translated to cardiovascular disease risk based on equations developed from a long-term cohort study. In this article, the implications of cardiovascular disease for life expectancy and medical costs are accounted for from a US payer perspective. RESULTS: The cardioprotective effect of sevelamer over 1 year is estimated to result in a 12% reduction in cardiovascular events compared with calcium acetate. In a population of 100 patients, the savings of 205,600 dollars accrued due to avoiding nine cardiovascular events with sevelamer, largely offset the increased binder costs, leading to a favorable cost-effectiveness ratio of about 2200 dollars per (discounted) life-year gained. CONCLUSIONS: Although both binders provide equivalent phosphate binding capacity, the results indicate that the advantage of 1 year of treatment with sevelamer in attenuating the progression of calcification has important clinical and economic consequences, suggesting that this provides good value for money.
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Authors | Krista F Huybrechts, J Jaime Caro, David A Wilson, Judith A O'Brien |
Journal | Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
(Value Health)
2005 Sep-Oct
Vol. 8
Issue 5
Pg. 549-61
ISSN: 1098-3015 [Print] United States |
PMID | 16176493
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Acetates
- Calcium Compounds
- Cardiotonic Agents
- Epoxy Compounds
- Phosphates
- Polyamines
- Polyethylenes
- Sevelamer
- calcium acetate
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Topics |
- Acetates
(economics, pharmacology, therapeutic use)
- Adult
- Aged
- Calcinosis
(economics, etiology, prevention & control)
- Calcium Compounds
- Cardiomyopathies
(economics, etiology, prevention & control)
- Cardiotonic Agents
(economics, pharmacology, therapeutic use)
- Cost-Benefit Analysis
- Direct Service Costs
- Epoxy Compounds
(economics, pharmacology, therapeutic use)
- Female
- Humans
- Kidney Failure, Chronic
(complications, therapy)
- Male
- Middle Aged
- Phosphates
(blood)
- Phosphorus Metabolism Disorders
(drug therapy, physiopathology)
- Polyamines
- Polyethylenes
(economics, pharmacology, therapeutic use)
- Proportional Hazards Models
- Quality-Adjusted Life Years
- Randomized Controlled Trials as Topic
- Regression Analysis
- Renal Dialysis
- Sevelamer
- Time
- United States
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