Cost-effectiveness of the oral adsorbent AST-120 versus placebo for chronic kidney disease.
OBJECTIVE
This study was designed to evaluate the cost-effectiveness of AST-120, an oral adsorbent that attenuates the progression of chronic kidney disease.


METHODS
We developed a Markov model with six health states, including four levels of serum creatinine, haemodialysis and death, using data from a randomized clinical trial conducted in Japan. Direct costs relevant to chronic kidney disease were calculated from a Japanese reimbursement perspective. Projected quality-adjusted life years (QALY) and costs were compared between the AST-120 and placebo groups. The target population was nondiabetic patients with serum creatinine levels from 5.0 to 8.0 mg/dL (442-707 micromol/L) at baseline. Probabilistic sensitivity analysis was performed to evaluate the stability of the results.


RESULTS
At 3 years, mean total costs per patient were estimated at 6.67 million yen (US$56,982) in the AST-120 group and 9.38 million yen (US$80,196) in the placebo group. Mean total costs were 2.72 million yen (US$23,205) lower among patients receiving AST-120. QALY per patient were 0.295 (approximately 3.5 months) greater for patients receiving AST-120 than for those receiving placebo over 3 years. The finding that treatment with AST-120 dominated placebo (i.e. was less costly and resulted in more QALY) was upheld in sensitivity analyses.


CONCLUSIONS
The use of AST-120 in patients with advanced chronic kidney disease may help to slow the rate of growth in expenditures for kidney disease.
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University, Durham, North Carolina 27715, USA.
Tomohiko
T
Takahashi
Shelby D
SD
Reed
Kevin A
KA
Schulman
D000284:Administration, Oral; D000327:Adsorption; D000328:Adult; D002244:Carbon / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012076:Renal Agents / Q000008:administration & dosage* / Q000191:economics*
D010087:Oxides; D012076:Renal Agents; D002244:Carbon; C040896:AST 120