Economic evaluation of sevelamer versus calcium-based phosphate binders in hemodialysis patients: a secondary analysis using centers for Medicare & Medicaid services data.
OBJECTIVE
A secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) trial suggested that sevelamer reduced hospitalizations relative to calcium-based phosphate binders. However, whether changed medical costs associated with reduced hospitalizations or other medical services offset the higher cost of sevelamer is unclear. This DCOR secondary analysis aimed to (1) evaluate Medicare total, inpatient, outpatient, skilled nursing facility, and other costs in sevelamer-treated versus calcium-treated patients; (2) examine Medicare costs in specific categories to determine cost drivers; and (3) estimate and incorporate sevelamer and calcium binder costs.


METHODS
DCOR trial participants were linked to the Centers for Medicare & Medicaid Services ESRD database. Medicare costs for 1895 dosed Medicare-primary-payer participants were evaluated. Phosphate binder costs were incorporated. Costs were indexed to 2001 (study base year). Sensitivity analyses were performed with randomized participants, two follow-up periods, and 2004 as index year.


RESULTS
Inflation-adjusted Medicare per member per month (PMPM) costs were lower for sevelamer-treated than for calcium-treated participants by a mean differential of $199 PMPM (mean, $5236 versus $5435; median, $4653 versus $4933), mainly because of lower inpatient costs for the sevelamer group (mean, $1461 versus $1644; median, $909 versus $1144). However, after phosphate binder costs were incorporated, costs trended lower for calcium-treated than for sevelamer-treated patients (differential -$81, 95% confidence interval -$321 to $157 PMPM, using average wholesale price; -$25, -$256 to $213 PMPM, using wholesale acquisition cost).


CONCLUSIONS
Sevelamer reduced inpatient Medicare costs compared with calcium binders. However, when binder costs were added, overall PMPM costs favored calcium-treated over sevelamer-treated participants.
St Peter
Wendy L
WL
Chronic Disease Research Group, Minneapolis Medical Research Foundation, University of Minnesota, Minneapolis, MN 55404, USA. WStPeter@cdrg.org
Fan
Qiao
Q
Weinhandl
Eric
E
Liu
Jiannong
J
D000085:Acetates / Q000191:economics* / Q000627:therapeutic use; D002119:Calcium Carbonate / Q000191:economics* / Q000627:therapeutic use; D017610:Calcium Compounds / Q000191:economics / Q000627:therapeutic use; D002614:Chelating Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000191:economics; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D010710:Phosphates / Q000378:metabolism; D011073:Polyamines / Q000191:economics* / Q000627:therapeutic use; D006435:Renal Dialysis; D000069603:Sevelamer; D016896:Treatment Outcome; D014481:United States
D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D010710:Phosphates; D011073:Polyamines; D000069603:Sevelamer; D002119:Calcium Carbonate; C120662:calcium acetate