Cost-effectiveness of sevelamer versus calcium carbonate plus atorvastatin to reduce LDL in patients with chronic renal insufficiency with dyslipidemia and hyperphosphatemia.
We conducted a cost-effectiveness analysis to compare costs and clinical outcomes of sevelamer versus calcium carbonate plus atorvastatin for treatment of dyslipidemia in patients with chronic renal insufficiency. The model was from the third-party payer perspective. Efficacy and adverse event rates for each regimen were obtained from published clinical trials. Drug costs were based on average wholesale prices; monitoring costs were based on Medicare reimbursement rates. Our model suggests that the combination of calcium carbonate plus atorvastatin is substantially more cost-effective than sevelamer in reducing low-density lipoprotein (LDL) in these patients. One-way sensitivity analyses were performed to assess if 25% and 50% price reductions in sevelamer affected overall cost-effectiveness results. A 50% sevelamer price reduction was less expensive than combination therapy but remained less cost-effective. A two-way sensitivity analysis on the probability that a patient achieves the goal of a 35% LDL reduction resulted in calcium carbonate plus atorvastatin remaining more cost-effective. Further cost-effectiveness studies are necessary to corroborate our data.
Department of Pharmacy, Virginia Commonwealth University, Richmond 23298-0533, USA.
D F
DF
Brophy
J F
JF
Wallace
D T
DT
Kennedy
T W
TW
Gehr
D A
DA
Holdford
D000069059:Atorvastatin; D002119:Calcium Carbonate / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004852:Epoxy Compounds / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs; D006538:Heptanoic Acids / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy* / Q000191:economics* / Q000209:etiology; D000960:Hypolipidemic Agents / Q000191:economics* / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000191:economics*; D008077:Lipoproteins, LDL / Q000097:blood*; D010710:Phosphates / Q000097:blood*; D011073:Polyamines; D011095:Polyethylenes / Q000191:economics* / Q000627:therapeutic use*; D011758:Pyrroles / Q000191:economics* / Q000627:therapeutic use*; D000069603:Sevelamer
D004852:Epoxy Compounds; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL; D010710:Phosphates; D011073:Polyamines; D011095:Polyethylenes; D011758:Pyrroles; D000069603:Sevelamer; D000069059:Atorvastatin; D002119:Calcium Carbonate