title: A modeled economic evaluation of sevelamer for treatment of hyperphosphatemia associated with chronic kidney disease among patients on dialysis in the United Kingdom.
abstract: OBJECTIVE
  There is limited information regarding the cost-effectiveness of sevelamer for the treatment of hyperphosphatemia in chronic kidney disease (CKD) patients on dialysis in the UK. Using a UK National Health Service (NHS) perspective and final results of the Dialysis Clinical Outcomes Revisited (DCOR) study, an evaluation was performed to determine the cost-effectiveness of sevelamer compared to calcium-based phosphate binders for the first-line treatment of hyperphosphatemia in CKD patients on dialysis.
  
  
  METHODS
  A Markov model was developed to estimate life years, quality-adjusted life years (QALYs), costs, incremental cost per life year (LY) gained, and QALY gained. Treatment-specific overall survival up to 44 months, hospitalizations, and resource utilization were derived from the DCOR study. Survival was extrapolated to a lifetime horizon using Weibull regression analysis. Unit costs and utility estimates specific to the UK were obtained from the published literature. Sub-group analyses were conducted based on data reported from the DCOR study for increasing age cut-points. Outcomes and costs were modeled for a lifetime horizon.
  
  
  RESULTS
  In the base case analysis, the use of sevelamer resulted in a gain of ∼0.73 LYs and 0.44 QALYs per patient (discounted at 3.5% per year). Total per-patient costs were higher for sevelamer, resulting in an incremental cost of £22,157 per QALY gained and £13,427 per LY gained (in £2009). Increasingly favorable cost per QALY ratios were observed with increasing age cut-points, ranging from £15,864 for patients ≥45 to £13,296 for patients ≥65 years of age. Results were most sensitive to assumptions regarding overall survival and the inclusion of dialysis costs. Key limitations of the analysis included the use of non-UK trial data for survival and hospitalizations, and the exclusion of quality-of-life impacts associated with hospitalization.
  
  
  CONCLUSIONS
  In CKD patients receiving dialysis, treatment of hyperphosphatemia with sevelamer offers good value for money compared with calcium-based binders.
authors.affiliation: Cornerstone Research Group Inc., Burlington, ON, Canada. lbernard@cornerstone-research.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Bernard
authors.forename: David
authors.initials: D
authors.lastname: Mendelssohn
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dunn
authors.forename: Colin
authors.initials: C
authors.lastname: Hutchison
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Grima
mesh_terms: D000367:Age Factors; D000368:Aged; D017610:Calcium Compounds / Q000191:economics / Q000627:therapeutic use; D002614:Chelating Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D011073:Polyamines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology; D000069603:Sevelamer; D013222:State Medicine; D016019:Survival Analysis; D006113:United Kingdom
chemical_list: D017610:Calcium Compounds; D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer