title: The cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in patients with end-stage renal disease.
abstract: OBJECTIVE
  To assess the cost-effectiveness of lanthanum carbonate (LC) as a second-line therapy for hyperphosphatemia in end-stage renal disease (ESRD) patients not achieving target phosphorus levels.
  
  
  METHODS
  A cohort of ESRD patients not adequately maintained on calcium carbonate (CC) and three subgroups of patients with baseline phosphorus levels of 5.6 to 6.5 mg/dl, 6.6 to 7.8 mg/dl, and more than 7.9 mg/dl were modeled. The following policy options were considered: continued CC (Policy 1); LC trial-if successful continue LC, if unsuccessful switch to CC (Policy 2). The survival benefit of using second-line LC to improve phosphorus control has been extrapolated from the relationship between hyperphosphatemia and mortality. Lifetime UK National Health Service drug and monitoring costs, expected survival, and quality-adjusted life-years (QALYs) were examined (discounting at 3.5% per annum).
  
  
  RESULTS
  Policy 2 had a cost-effectiveness ratio (cost/QALY) of pound25,033 relative to Policy 1. The results show it is particularly cost-effective to treat patients with phosphorus levels above 6.6 mg/dl. The outcomes did not vary significantly during the one-way sensitivity analysis carried out on important model parameters and assumptions except when the utility value for ESRD was decreased by more than 30%.
  
  
  CONCLUSIONS
  Applying a cost-effectiveness threshold of pound30,000 per QALY, the model shows it is cost-effective to follow current treatment guidelines and treat all patients who are not adequately maintained on CC (serum phosphorus above 5.6 mg/dl) with second-line LC. This is particularly the case for patients with serum phosphorus above 6.6 mg/dl. Our estimates are probably conservative as the possible compliance difference in favor of LC and the reduced number of hypercalcemic events with LC relative to CC was not considered.
authors.affiliation: Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK. a.brennan@sheffield.ac.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Brennan
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
authors.forename: Sarah
authors.initials: S
authors.lastname: Davis
authors.forename: Hana
authors.initials: H
authors.lastname: Sakai
authors.forename: Victoria
authors.initials: V
authors.lastname: Abbott
mesh_terms: D017326:Clinical Trials, Phase III as Topic; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017050:Episode of Care; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000191:economics; D007811:Lanthanum / Q000191:economics / Q000627:therapeutic use*; D017059:Models, Econometric; D010760:Phosphorus Metabolism Disorders / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D006113:United Kingdom; D026712:Value of Life / Q000191:economics*
chemical_list: C119467:lanthanum carbonate; D007811:Lanthanum