title: Reduced use of erythropoiesis-stimulating agents and intravenous iron with ferric citrate: a managed care cost-offset model.
abstract: BACKGROUND
  Ferric citrate (FC) is a phosphate binder in development for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). In clinical trials, FC improved patient serum phosphorus levels and increased serum ferritin and percent transferrin saturation. Because nephrologists respond to increases in these iron measures by reducing intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) doses, the decreased use of iron and ESA associated with FC may reduce costs.
  
  
  OBJECTIVE
  To develop a cost-offset model from a managed care perspective estimating the cost savings associated with FC use.
  
  
  METHODS
  We created a cost-offset model from the managed care payer perspective that compared the treatment costs of ESRD for patients given FC. The model considered the number of dialysis sessions per month; number of ESRD patients enrolled in the health plan; cost of ESAs, iron, and dialysis sessions; and the proportion of patients on phosphate binder therapy. The model assumed equivalent efficacy and cost neutrality between FC and other phosphate binders. Monte Carlo simulations were conducted by varying model inputs.
  
  
  RESULTS
  When FC was compared to other phosphate binders, the monthly cost of ESA and IV iron per 500 patients with ESRD (85% treated with phosphate binders) was reduced by 8.15% and 33.2%, respectively. When incorporated into the total cost of dialysis for patients with ESRD (dialysis, ESA, and IV iron), the decrease in the monthly cost of dialysis care was US$80,214 per 500 ESRD patients. Monte Carlo simulations suggest that a plan serving 500 dialysis patients could save between US$626,000 and US$1,106,000 annually with the use of FC.
  
  
  CONCLUSIONS
  The use of FC in ESRD patients with hyperphosphatemia may help reduce treatment costs.
authors: DaVita Clinical Research, Minneapolis, MN, USA.
authors: Richard
authors: R
authors: Mutell
authors: Jaime L
authors: JL
authors: Rubin
authors: T Christopher
authors: TC
authors: Bond
authors: Tracy
authors: T
authors: Mayne
keywords: dialysis; end-stage renal disease; hemodialysis; hyperphosphatemia; phosphate binders
references: Fed Regist. 2011 Nov 10;76(218):70228-316
references: 22103020
references: Am J Kidney Dis. 2003 Oct;42(4 Suppl 3):S1-201
references: 14520607
references: Am J Kidney Dis. 2008 Dec;52(6 Suppl):S29-33
references: 19010259
references: Nephrol Dial Transplant. 2002 Feb;17(2):265-70
references: 11812877
references: N Engl J Med. 2011 Feb 17;364(7):596-8
references: 21323539
references: Best Pract Res Clin Endocrinol Metab. 2011 Aug;25(4):647-55
references: 21872805
references: J Am Soc Nephrol. 2008 Feb;19(2):372-9
references: 18216316
references: Kidney Int Suppl. 2009 Aug;(113):S1-130
references: 19644521
references: Am J Kidney Dis. 2006 May;47(5 Suppl 3):S11-145
references: 16678659
references: Clin J Am Soc Nephrol. 2010 Mar;5(3):519-30
references: 20093346
references: Am J Kidney Dis. 2012 Jan;59(1 Suppl 1):A7, e1-420
references: 22177944
references: Clin J Am Soc Nephrol. 2009 Dec;4(12):1954-61
references: 19833904
references: Am J Kidney Dis. 2011 Mar;57(3):422-31
references: 21239096
references: J Am Soc Nephrol. 2007 Mar;18(3):975-84
references: 17267740