title: Cost-effectiveness of lanthanum carbonate versus sevelamer hydrochloride for the treatment of hyperphosphatemia in patients with end-stage renal disease: a US payer perspective.
abstract: OBJECTIVE
  To assess the cost-effectiveness of lanthanum carbonate (LC) versus sevelamer hydrochloride (SH) as a treatment for hyperphosphatemia in end-stage renal disease (ESRD) patients.
  
  
  METHODS
  A Markov model was developed to estimate health outcomes; quality-adjusted life years (QALYs) and life-years saved (LYS), as well as associated costs. The model incorporated patient-level data from a randomized head-to-head crossover study that compared the reduction of serum phosphorus using LC and SH for 4 weeks each. The model included patients previously treated with calcium-based binders. Both the intent-to-treat (ITT) population and the cohort of patients who completed treatment in both periods of the study (i.e., completer population) were assessed. The baseline risks of cardiovascular disease (CVD), all-cause mortalities for CVD, and non-CVD patients were derived from a large US renal database. Patient outcomes were modeled for 10 years, and incremental cost-effectiveness ratios (ICERs) were calculated for LC relative to SH. Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the base-case model.
  
  
  RESULTS
  For the ITT population, the ICERs of LC versus SH were $24,724/QALY and $15,053/LYS, respectively (in US dollars). When the completer population was considered, the ICERs of LC versus SH were $15,285/QALY and $9,337/LYS (Table 2), respectively. The PSA indicated 61.9% and 85.8% probabilities for ITT and completer populations of LC being cost-effective at the $50,000/QALY willingness-to-pay threshold, respectively.
  
  
  CONCLUSIONS
  LC is a cost-effective strategy compared with SH in the treatment of ESRD patients with hyperphosphatemia who were previously treated with calcium-based binders. Sensitivity analyses demonstrated the robustness of the pharmacoeconomic model.
authors.affiliation: University of Texas at Austin College of Pharmacy, Austin, TX, USA.
authors.forename: Haesuk
authors.initials: H
authors.lastname: Park
authors.forename: Karen L
authors.initials: KL
authors.lastname: Rascati
authors.forename: Michael S
authors.initials: MS
authors.lastname: Keith
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgkins
authors.forename: Michael
authors.initials: M
authors.lastname: Smyth
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology; D002614:Chelating Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018592:Cross-Over Studies; D016208:Databases, Factual; D017850:Economics, Pharmaceutical; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000191:economics; D007811:Lanthanum / Q000191:economics / Q000627:therapeutic use*; D008390:Markov Chains; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D011073:Polyamines / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000069603:Sevelamer; D014481:United States
chemical_list: D002614:Chelating Agents; D011073:Polyamines; C119467:lanthanum carbonate; D007811:Lanthanum; D000069603:Sevelamer