title: Cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in chronic kidney disease before and during dialysis.
abstract: OBJECTIVE
  Hyperphosphatemia is a common and harmful condition in patients with chronic kidney disease (CKD). We determined the cost-effectiveness of the noncalcium-based phosphate binder lanthanum carbonate (LC) as second-line treatment of hyperphosphatemia after therapy failure with calcium-based binders (CB).
  
  
  METHODS
  Two CKD populations were modeled: 1) predialysis CKD patients and 2) incident dialysis patients. Patients not responding to CB with a serum phosphate (SP) level >5.5 mg/dl received a trial with LC. Patients not responding to LC (SP >4.6 mg/dl) returned to CB treatment. Patient-level data were obtained from clinical trials in predialysis and dialysis. Time-dependent, life-long Markov models (discounting at 3.5% annually) were developed, using a UK National Health Service perspective.
  
  
  RESULTS
  The health gains with second-line LC treatment compared to CB treatment were 44 and 56 quality-adjusted life-years (QALYs) for the predialysis and incident dialysis populations, respectively. Second-line LC was a cost-saving strategy in the predialysis population because of the cost-savings of delayed CKD progression. Second-line LC was cost-effective at £6900 (90% probability interval: £5800-£8300) per QALY gained in the dialysis population. Results were robust to plausible variations in other model parameters; inclusion of future unrelated dialysis costs had a large influence on cost-effectiveness estimates.
  
  
  CONCLUSIONS
  Second-line treatment with LC is associated with considerable clinical benefits and good value for money in CKD, irrespective of dialysis status. These results support Kidney Disease Outcomes Quality Initiative guidelines to treat CKD patients with hyperphosphatemia irrespective of dialysis status.
authors.affiliation: Department of Pharmacy, Unit of PharmacoEpidemiology and PharmacoEconomics (PE(2)), University of Groningen, Groningen, The Netherlands. s.vegter@rug.nl
authors.forename: Stefan
authors.initials: S
authors.lastname: Vegter
authors.forename: Keith
authors.initials: K
authors.lastname: Tolley
authors.forename: Michael S
authors.initials: MS
authors.lastname: Keith
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007811:Lanthanum / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D013222:State Medicine; D006113:United Kingdom
chemical_list: C119467:lanthanum carbonate; D007811:Lanthanum