title: Net Budgetary Impact of Ferric Citrate as a First-Line Phosphate Binder for the Treatment of Hyperphosphatemia: A Markov Microsimulation Model.
abstract: Ferric citrate (FC) has demonstrated efficacy as a phosphate binder and reduces the requirements for erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron in dialysis patients. We developed a net budgetary impact model to evaluate FC vs. other phosphate binders from the vantage of a large dialysis provider. We used a Markov microsimulation model to simulate mutually referential longitudinal effects between serum phosphate and phosphate binder dose; categories of these defined health states. Health states probabilistically determined treatment attendance and utilization of ESA and IV iron. We derived model inputs from a retrospective analysis of incident phosphate binder users from a large dialysis organization (January 2011-June 2013) and incorporated treatment effects of FC from a phase III trial. The model was run over a 1-year time horizon. We considered fixed costs of providing dialysis; costs of administering ESA and IV iron; and payment rates for dialysis, ESAs, and IV iron. In the base-case model, FC had a net budgetary impact (savings) of +US$213,223/year per 100 patients treated vs. standard of care. One-way sensitivity analyses showed a net budgetary impact of up to +US$316,296/year per 100 patients treated when higher hemoglobin levels observed with FC translated into a 30% additional ESA dose reduction, and up to +US$223,281/year per 100 patients treated when effects on missed treatment rates were varied. Two-way sensitivity analyses in which acquisition costs for ESA and IV iron were varied showed a net budgetary impact of +US$104,840 to +US$213,223/year per 100 patients treated. FC as a first-line phosphate binder would likely yield substantive savings vs. standard of care under current reimbursement.
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Suite 300, Minneapolis, MN, 55404, USA. Steven.Brunelli@DaVita.com.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
authors.affiliation: DaVita Clinical Research, 825 South 8th Street, Suite 300, Minneapolis, MN, 55404, USA.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Sibbel
authors.affiliation: DaVita Inc., Denver, CO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Van Wyck
authors.affiliation: Keryx Biopharmaceuticals Inc., New York, NY, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Keryx Biopharmaceuticals Inc., New York, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hsieh
authors.affiliation: Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
mesh_terms: D004305:Dose-Response Relationship, Drug; D005290:Ferric Compounds / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D006397:Hematinics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D054559:Hyperphosphatemia / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D008390:Markov Chains; D010710:Phosphates / Q000097:blood*; D012189:Retrospective Studies
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D010710:Phosphates; C025314:ferric citrate