title: Sevelamer is cost-saving vs. calcium carbonate in non-dialysis-dependent CKD patients in italy: a patient-level cost-effectiveness analysis of the INDEPENDENT study.
abstract: OBJECTIVE
  To conduct a cost-effectiveness analysis of sevelamer versus calcium carbonate in patients with non-dialysis-dependent CKD (NDD-CKD) from the Italian NHS perspective using patient-level data from the INDEPENDENT-CKD study.
  
  
  METHODS
  Patient-level data on all-cause mortality, dialysis inception and phosphate binder dose were obtained for all 107 sevelamer and 105 calcium carbonate patients from the INDEPENDENT-CKD study. Hospitalization and frequency of dialysis data were collected post hoc for all patients via a retrospective chart review. Phosphate binder, hospitalization, and dialysis costs were expressed in 2012 euros using hospital pharmacy, Italian diagnosis-related group and ambulatory tariffs, respectively. Total life years (LYs) and costs per treatment group were calculated for the 3-year period of the study. Bootstrapping was used to estimate confidence intervals around outcomes, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve. A subgroup analysis of patients who did not initiate dialysis during the INDEPENDENT-CKD study was also conducted.
  
  
  RESULTS
  Sevelamer was associated with 0.06 additional LYs (95% CI -0.04 to 0.16) and cost savings of EUR -5,615 (95% CI -10,066 to -1,164) per patient compared with calcium carbonate. On the basis of the bootstrap analysis, sevelamer was dominant compared to calcium carbonate in 87.1% of 10,000 bootstrap replicates. Similar results were observed in the subgroup analysis. RESULTS were driven by a significant reduction in all-cause mortality and significantly fewer hospitalizations in the sevelamer group, which offset the higher acquisition cost for sevelamer.
  
  
  CONCLUSIONS
  Sevelamer provides more LYs and is less costly than calcium carbonate in patients with NDD-CKD in Italy.
authors.affiliation: Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Filippo
authors.initials: F
authors.lastname: Cipriani
authors.forename: Antonio
authors.initials: A
authors.lastname: Bellasi
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.forename: Biagio
authors.initials: B
authors.lastname: Di Iorio
mesh_terms: D000368:Aged; D002119:Calcium Carbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D002423:Cause of Death; D002614:Chelating Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011073:Polyamines / Q000008:administration & dosage / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D000069603:Sevelamer; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer; D002119:Calcium Carbonate