Cost-effectiveness of administering oral adsorbent AST-120 to patients with diabetes and advance-stage chronic kidney disease.
OBJECTIVE
AST-120, an oral adsorbent currently on-label only in Asian countries with phase III trials ongoing in the US, slows renal disease progression in patients with diabetes and advanced-stage chronic kidney disease (CKD). The objective of this study is to evaluate the cost-effectiveness of using AST-120 to treat patients with type 2 diabetes and advanced-stage CKD.


METHODS
We used Markov model simulating the progression of diabetic nephropathy. Data were obtained from randomized trials estimating the progression of diabetic nephropathy with and without AST-120, and published literature. The base population was patients 60 years of age with type 2 diabetes and Stages 3 and 4 CKD.


RESULTS
Treating patients with diabetes and advanced-stage CKD was found to be a dominant strategy, and quality of life improved further and more money was saved (0.22 quality-adjusted life years [QALYs] and $15,019 per patient) using AST-120 than the control strategy. Sensitivity analysis results were robust with regard to cost, adherence, and quality of life associated with AST-120 therapy, as well as age at diagnosis. The model was relatively sensitive to the effectiveness of AST-120.


CONCLUSIONS
Treating patients with type 2 diabetes and advanced-stage CKD with AST-120 appears to extend life and reduce costs.
Hayashino
Yasuaki
Y
Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine, Yoshida, Kyoto 606-8501, Japan. hayasino-y@umin.net
Fukuhara
Shunichi
S
Akizawa
Tadao
T
Asano
Yasushi
Y
Wakita
Takafumi
T
Onishi
Yoshihiro
Y
Kurokawa
Kiyoshi
K
D000284:Administration, Oral; D000368:Aged; D002244:Carbon / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000517:prevention & control; D010087:Oxides / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control
D002244:Carbon; D003404:Creatinine; D006442:Glycated Hemoglobin; D010087:Oxides; C040896:AST 120