Health and economic consequences of sevelamer use for hyperphosphatemia in patients on hemodialysis.
OBJECTIVE
The safety and efficacy of sevelamer hydrochloride in binding phosphate in patients with end-stage renal disease and its ability to attenuate the progression of cardiac calcification have been well documented but not the longer-term health and economic implications. Thus, a model of the predicted long-term consequences of sevelamer compared with calcium-based binders (acetate and carbonate) was developed.


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.
Huybrechts
Krista F
KF
Caro Research Institute, Concord, MA 01742, USA. khuybrechts@caroresearch.com
Caro
J Jaime
JJ
Wilson
David A
DA
O'Brien
Judith A
JA
D000085:Acetates / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D017610:Calcium Compounds; D009202:Cardiomyopathies / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D002316:Cardiotonic Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004852:Epoxy Compounds / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood; D010760:Phosphorus Metabolism Disorders / Q000188:drug therapy* / Q000503:physiopathology; D011073:Polyamines; D011095:Polyethylenes / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D006435:Renal Dialysis; D000069603:Sevelamer; D013995:Time; D014481:United States
D000085:Acetates; D017610:Calcium Compounds; D002316:Cardiotonic Agents; D004852:Epoxy Compounds; D010710:Phosphates; D011073:Polyamines; D011095:Polyethylenes; D000069603:Sevelamer; C120662:calcium acetate