Abstract | BACKGROUND: OBJECTIVES: The primary objective of the present study was to assess the costs and clinical benefits of second-line use of LC after therapy failure with CC in patients receiving dialysis, from a Canadian payer perspective. The secondary objective was to perform an economic comparison between second-line LC therapy and second-line SH therapy, from a Canadian payer perspective. Short-term outcomes were treatment response and cost per additional responder, and long-term outcomes were survival, number of all-cause hospitalizations, and quality of life. METHODS: A cost-effectiveness Markov model was populated with simulated cohorts of 1000 patients receiving incident dialysis, followed life-long. Patients not responsive to CC with a serum phosphate concentration >1.78 mmol/L (>5.5 mg/dL) received a trial regimen with LC. Patients not responsive to LC returned to CC therapy. Patient data from a randomized controlled trial of 800 patients receiving dialysis were used. Extensive (probabilistic) sensitivity analyses were performed. When available, model parameters were based on Canadian data or from a Canadian perspective. All costs are in 2010 Canadian dollars (C$). RESULTS: Results of the model estimated that in patients responsive to second-line LC therapy, survival increased, on average, 0.44 years (95% confidence interval [CI], 0.35-0.54) per patient when compared with continued CC therapy. The mean (range) costs per patient in the first year of treatment with LC was C$2600 (C$2400-C$2800). Over patients' lifetimes, the second-line LC strategy resulted in a gain of 48.8 (37.1-61.3) life-years and 29.3 (21.4-38.1) quality-adjusted life-years (QALYs). The cost-effectiveness of the second-line LC strategy was C$7900 (C$1800-C$14,600) per life-year and C$13,200 (C$3000-C$25,100) per QALY gained. Most sensitivity analyses did not change the cost-effectiveness outcomes; however, including unrelated future costs raised the incremental cost-effectiveness ratio to C$159,500 (95% confidence interval, C$133,300-C$191,600) per QALY gained. Compared with second-line SH therapy, second-line LC therapy had similar effectiveness and was 23% less expensive. CONCLUSIONS: Second-line treatment with LC is cost-effective in the treatment of end-stage kidney disease in patients with hyperphosphatemia, from a Canadian payer perspective. Second-line treatment with LC is less expensive, with similar effectiveness as second-line treatment with SH. The primary limitation of health economic evaluations of phosphate binders is the relative scarcity of clinical data on the association between phosphate concentration and long-term outcome.
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Authors | Stefan Vegter, Keith Tolley, Michael S Keith, Charmaine E Lok, Steven D Soroka, A Ross Morton |
Journal | Clinical therapeutics
(Clin Ther)
Vol. 34
Issue 7
Pg. 1531-43
(Jul 2012)
ISSN: 1879-114X [Electronic] United States |
PMID | 22742885
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved. |
Chemical References |
- Chelating Agents
- Polyamines
- lanthanum carbonate
- Lanthanum
- Sevelamer
|
Topics |
- Canada
- Chelating Agents
(economics, therapeutic use)
- Clinical Trials, Phase III as Topic
- Cost-Benefit Analysis
- Follow-Up Studies
- Hospitalization
(economics, statistics & numerical data)
- Humans
- Hyperphosphatemia
(drug therapy, economics, etiology)
- Kidney Failure, Chronic
(complications, economics, therapy)
- Lanthanum
(economics, therapeutic use)
- Markov Chains
- Models, Economic
- Polyamines
(economics, therapeutic use)
- Quality of Life
- Quality-Adjusted Life Years
- Randomized Controlled Trials as Topic
- Renal Dialysis
(methods)
- Sevelamer
- Survival Rate
- Treatment Outcome
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