[Phosphorus (P) chelant in dialysis: efficacy and cost. Peritoneal dialysis solutions].
Sevelamer use has a high prevalence, and half of patients are treated with this noncalcium binder. Two randomized studies appeared in 2007 that compared the efficacy of sevelamer over calcium salts. In the more statistically potent of the two studies, no differences were found in mortality between the sevelamer and calcium groups, except for a benefit in favor of sevelamer in patients older than 65 years. In the other less statistically potent study, lower mortality was observed in the sevelamer group. Both studies have various deficiencies and a timely meta-analysis of the two studies appearing that same year concluded that there was no significant evidence demonstrating a superior efficacy of sevelamer over calcium salts. Therefore, generalized extension of its use as a first-line binder is not recommended. However, its use can be assessed in specific clinical situations. With regard to the cost-benefit ratio, as there is no evidence that greater clinical benefits are obtained with sevelamer than with calcium salts, prudence and moderation in its use are needed because of the high cost/benefit ratio demonstrated. Otherwise, we will contribute to increasing the already very high treatment cost in these patients, with one of the highest costs per life year gained in medicine. The cost/benefit ratio of sevelamer remains unattractive from an economic point of view, even if dialysis and transplant are excluded in these patients.
Jefe del Servicio de Nefrologia, Hostpial de Galdakao, Vizcaya, Spain.
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Montenegro
D000368:Aged; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use; D002614:Chelating Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D015913:Chelation Therapy / Q000191:economics / Q000379:methods*; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000191:economics / Q000379:methods; D010758:Phosphorus; D011073:Polyamines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000069603:Sevelamer
D002614:Chelating Agents; D015312:Hemodialysis Solutions; D011073:Polyamines; D010758:Phosphorus; D000069603:Sevelamer; D002118:Calcium
Quelantes de fósforo (P) en diálisis: eficacia y coste. Soluciones de diálisis peritoneal.