title: Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in Japan.
abstract: OBJECTIVE
  Lanthanum carbonate (LC) is a nonaluminum, noncalcium phosphate binder that is effective for hyperphosphatemia in dialysis patients. However, its efficacy and cost-effectiveness as second-line therapy have not been fully examined.
  
  
  METHODS
  We first conducted a multicenter, open-label, 16-week clinical trial to examine the effect of additive LC in 116 hemodialysis patients who had uncontrolled hyperphosphatemia with conventional phosphorus-lowering therapy alone. Based on these clinical data, a state transition model was developed to evaluate the benefits and costs associated with LC as second-line therapy. Reduced risks for cardiovascular morbidity and mortality among patients treated with LC arise through more of the population achieving the target phosphorus levels. Uncertainty was explored through sensitivity analysis.
  
  
  RESULTS
  After 16 weeks of additive LC treatment, mean serum phosphorus levels decreased from 7.30 ± 0.90 to 5.71 ± 1.32 mg/dl, without significant changes in serum calcium or intact parathyroid hormone levels. A subsequent cost-effectiveness analysis showed that compared with conventional treatment, additive LC incurred an average additional lifetime cost of $22,054 per person and conferred an additional 0.632 quality-adjusted life years (QALYs). This resulted in an incremental cost-effectiveness ratio of $34,896 per QALY gained. Applying a cost-effectiveness threshold of $50,000 per QALY, a probabilistic sensitivity analysis showed that additive LC had a 97.4% probability of being cost-effective compared with conventional treatment.
  
  
  CONCLUSIONS
  Our results indicate that the use of LC as second-line therapy would be cost-effective among hemodialysis patients with uncontrolled hyperphosphatemia in Japan.
authors.affiliation: Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Goto
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.forename: Kensuke
authors.initials: K
authors.lastname: Moriwaki
authors.forename: Akira
authors.initials: A
authors.lastname: Fujimori
authors.forename: Koji
authors.initials: K
authors.lastname: Shibuya
authors.forename: Masato
authors.initials: M
authors.lastname: Nishioka
authors.forename: Jong-Il
authors.initials: JI
authors.lastname: Kim
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshiya
authors.forename: Jeongsoo
authors.initials: J
authors.lastname: Shin
authors.forename: Hirohito
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Masatomo
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishi
authors.forename: Isao
authors.initials: I
authors.lastname: Kamae
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D002614:Chelating Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D007564:Japan; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000191:economics / Q000628:therapy*; D007811:Lanthanum / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010758:Phosphorus / Q000097:blood*; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D010758:Phosphorus; C119467:lanthanum carbonate; D007811:Lanthanum