title: Economic Evaluation of Sevelamer versus Calcium-based Binders in Treating Hyperphosphatemia among Patients with End-stage Renal Disease in China.
abstract: To conduct a cost-effectiveness analysis study of sevelamer versus calcium-based binders (CBBs) in treating hyperphosphatemia among patients with end-stage renal disease (ESRD) in China.
  
  
  
  A decision-analytic model of a lifetime horizon was used for base case analysis from the payers' perspective. The transition probabilities between different health states were derived from survival analysis. The overall survival of CBBs was derived from the Dialysis Clinical Outcomes Revisited study for up to 44 months and a Weibull regression model was used to extrapolate the overall survival to a lifetime horizon. A hazard ratio (0.54; 95% CI, 0.32-0.93) of the overall survival for sevelamer versus CBBs was used to calculate the survival of the sevelamer group. Clinical and cost data were derived from literature and health care system in the local setting. Incremental life year and quality-adjusted life year (QALY) were the primary outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the model assumptions and parameters. The results were reported in 2015 Chinese Renminbi.
  
  
  
  The incremental cost per life year and per QALY gained of sevelamer versus CBBs was ¥44,475 and ¥57,910, respectively. The incremental cost per QALY gained was below the World Health Organization's recommended cost-effectiveness threshold (¥151,070), which is 3 times the gross domestic product per capita of 2015 in China. The incremental cost-effectiveness ratio was most sensitive to the hazard ratio of overall survival with sevelamer versus CBBs in the 1-way sensitivity analysis. The cost-effectiveness acceptability curve indicated that sevelamer had a 89.6% likelihood of cost-effectiveness at the ¥151,070 threshold.
  
  
  
  Sevelamer is likely to be a cost-effective option in treating hyperphosphatemia among patients with ESRD compared with CBBs in the local context of China.
authors.affiliation: Peking University Health Science Centre, Beijing, China. Electronic address: lyang@bjmu.edu.cn.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.affiliation: IMS Health Asia Pacific, Singapore.
authors.forename: Seng
authors.initials: S
authors.lastname: Chuen Tan
authors.affiliation: IMS Health Asia Pacific, Singapore.
authors.forename: Can
authors.initials: C
authors.lastname: Chen
authors.affiliation: IMS Health Asia Pacific, Singapore.
authors.forename: Xingzhi
authors.initials: X
authors.lastname: Wang
authors.affiliation: Peking University Health Science Centre, Beijing, China.
authors.forename: Xinya
authors.initials: X
authors.lastname: Li
authors.affiliation: Sanofi China, Shanghai, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Yang
mesh_terms: D002118:Calcium / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use; D002681:China; D003362:Cost-Benefit Analysis; D006801:Humans; D054559:Hyperphosphatemia / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D019057:Quality-Adjusted Life Years; D000069603:Sevelamer / Q000627:therapeutic use*; D016019:Survival Analysis
chemical_list: D002614:Chelating Agents; D000069603:Sevelamer; D002118:Calcium
keywords: China; calcium-based binders; cost-effectiveness analysis; hyperphosphatemia; sevelamer