title: Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review.
abstract: Managing hyperphosphataemia in haemodialysis patients is resource-intensive. A search for cost-effective interventions in this field is needed to inform decisions on the allocation of healthcare resources. NHSEED, MEDLINE, EMBASE and CINAHL were searched for full economic evaluations of hyperphosphataemia-managing interventions in adult haemodialysis patients, published between 2004 and 2014, in English, French, Dutch or German. Incremental cost-effectiveness ratios of the interventions were up-rated to 2013US$ using Purchasing Power Parity conversion rates and Consumer Price Indices. The quality of included studies was assessed using the Extended Consensus on Health Economic Criteria List. Twelve out of the 1681 retrieved records fulfilled the inclusion criteria. They reported only on one aspect of hyperphosphataemia management, which is the use of phosphate binders (calcium-based and calcium-free, in first-line and sequential use). No economic evaluations of other phosphorus-lowering interventions were found. The included articles derived from five countries and most of them were funded by pharmaceutical companies. The incremental cost-effectiveness ratios of phosphate binders ranged between US$11 461 and US$157 760 per quality-adjusted life-year gained. Calcium-based binders (especially calcium acetate) appear to be the optimal cost-effective first- and second-line therapy in prevalent patients, while the calcium-free binder, lanthanum carbonate, might provide good value for money, as second-line therapy, in incident patients. The studies' overall quality was suboptimal. Drawing firm conclusions was not possible due to the quality heterogeneity and inconsistent results. Future high-quality economic evaluations are needed to confirm the findings of this review and to address other interventions to manage hyperphosphataemia in this population.
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Rana
authors.identifier: http://orcid.org/0000-0002-8850-6502
authors.initials: R
authors.lastname: Rizk
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Mickaël
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Department of Natural Sciences in Public Health, College of Sustainability Sciences and Humanities, Zayed University, Dubai, United Arab Emirates.
authors.forename: Mirey
authors.initials: M
authors.lastname: Karavetian
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Silvia Maa
authors.initials: SM
authors.lastname: Evers
mesh_terms: D015415:Biomarkers / Q000097:blood; D002614:Chelating Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D018803:Models, Economic; D010710:Phosphates / Q000097:blood*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000009:adverse effects* / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; D010710:Phosphates
keywords: chronic; cost-benefit analysis; hyperphosphataemia; kidney failure; renal dialysis