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.
Takahashi
Tomohiko
T
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University, Durham, North Carolina 27715, USA.
Reed
Shelby D
SD
Schulman
Kevin A
KA
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