Prevention and management of hyperphosphatemia with sevelamer in Canada: health and economic consequences.
BACKGROUND
Sevelamer hydrochloride (Renagel) binds phosphate in patients with end-stage renal disease without the use of exogenous calcium and may reduce the progression of coronary vascular calcification. This intervention was shown to be cost-effective in the United States. This paper presents the Canadian adaptation.


METHODS
A discrete event simulation of the long-term cardiovascular implications of 1 year of phosphate binding in a prevalent hemodialysis population was used to estimate the cost-effectiveness of sevelamer use in Canada based on the demographics, comorbidities, physiological and renal characteristics. Initial calcification score and expected changes over 1 year were derived using regression equations developed from a clinical trial and translated to cardiovascular disease risk based on equations developed from a long-term cohort study. Direct medical costs from a Canadian Medicare perspective were taken from Ontario data. Ten replications of 10,000 patients over 13 years (discounting at 3%) were done for the base case and extensive sensitivity analyses were conducted.


RESULTS
The cardioprotective effect of sevelamer over 1 year is estimated to prevent 10 cardiovascular events and gain 18 life-years compared with calcium carbonate in 100 patients over a lifetime. These benefits are obtained at a net cost of CAD$2,096; an incremental cost-effectiveness ratio of CAD$12,384 per discounted life-year gained. Sensitivity analyses showed that the time horizon and efficacy were the most important factors.


CONCLUSIONS
The results of this study provide evidence that use of sevelamer in Canada would be economically sound.
Huybrechts
Krista F
KF
Caro Research Institute, Concord, MA 01742, USA. krista.huybrechts@unitedbiosource.com
Caro
J Jaime
JJ
O'Brien
Judith A
JA
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000517:prevention & control; D002119:Calcium Carbonate / Q000191:economics* / Q000627:therapeutic use; D002170:Canada; D002318:Cardiovascular Diseases / Q000191:economics* / Q000517:prevention & control*; D002614:Chelating Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011073:Polyamines / Q000191:economics* / Q000627:therapeutic use; D000069603:Sevelamer
D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer; D002119:Calcium Carbonate