title: Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study.
abstract: BACKGROUND
  The recent multicenter, randomized, open-label INDEPENDENT study demonstrated that sevelamer improves survival in new to hemodialysis (HD) patients compared with calcium carbonate. The objective of this study was to determine the cost-effectiveness of sevelamer versus calcium carbonate for patients new to HD, using patient-level data from the INDEPENDENT study.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Adult patients new to HD in Italy.
  
  
  METHODS
  A patient-level cost-effectiveness analysis was conducted from the perspective of the Servizio Sanitario Nazionale, Italy's national health service. The analysis was conducted for a 3-year time horizon. The cost of dialysis was excluded from the base case analysis.
  
  
  METHODS
  Sevelamer was compared to calcium carbonate.
  
  
  RESULTS
  Total life years (LYs), total costs, and the incremental cost per LY gained were calculated. Bootstrapping was used to estimate confidence intervals around LYs, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve.
  
  
  RESULTS
  Sevelamer was associated with a gain of 0.26 in LYs compared to calcium carbonate, over the 3-year time horizon. Total drug costs were €3,282 higher for sevelamer versus calcium carbonate, while total hospitalization costs were €2,020 lower for sevelamer versus calcium carbonate. The total incremental cost of sevelamer versus calcium carbonate was €1,262, resulting in a cost per LY gained of €4,897. The bootstrap analysis demonstrated that sevelamer was cost effective compared with calcium carbonate in 99.4 % of 10,000 bootstrap replicates, assuming a willingness-to-pay threshold of €20,000 per LY gained.
  
  
  CONCLUSIONS
  Data on hospitalizations was taken from a post hoc retrospective chart review of the patients included in the INDEPENDENT study. Patient quality of life or health utility was not included in the analysis.
  
  
  CONCLUSIONS
  Sevelamer is a cost-effective alternative to calcium carbonate for the first-line treatment of hyperphosphatemia in new to HD patients in Italy.
authors.affiliation: Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ruggeri
authors.affiliation: Division of Nephrology, Sant'Anna Hospital, Como, Italy.|Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
authors.affiliation: Market Access and Corporate Affairs, Genzyme, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Division of Renal Dis and Hypertension, Department of Medicine, University of Texas Houston Medical School, Houston, TX, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Molony
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of Texas Houston Medical School, Houston, TX, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bell
authors.affiliation: Department of Nephrology, School of Medicine, Federico II University, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.affiliation: Department of Nephrology, Ospedale A. Landolfi di Solofra, Solofra (AV), Italy. br.diiorio@gmail.com.
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
mesh_terms: D000368:Aged; D000863:Antacids / Q000008:administration & dosage / Q000191:economics; D002119:Calcium Carbonate / Q000008:administration & dosage* / Q000191:economics; D002614:Chelating Agents / Q000008:administration & dosage / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D000069603:Sevelamer / Q000008:administration & dosage* / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000863:Antacids; D002614:Chelating Agents; D000069603:Sevelamer; D002119:Calcium Carbonate
keywords: Calcium carbonate; Chronic kidney disease; Cost effectiveness; Dialysis; Hyperphosphatemia; Sevelamer