The cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in patients with end-stage renal disease.
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.
Brennan
Alan
A
Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK. a.brennan@sheffield.ac.uk
Akehurst
Ron
R
Davis
Sarah
S
Sakai
Hana
H
Abbott
Victoria
V
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*
C119467:lanthanum carbonate; D007811:Lanthanum