title: A Real-world Cost-effectiveness Analysis of Sevelamer Versus Calcium Acetate in Korean Dialysis Patients.
abstract: Sevelamer, a noncalcium phosphate binder, has been shown to attenuate the progression of vascular calcification and improve survival in patients with chronic kidney disease undergoing dialysis compared with calcium-based binders. Using real-world data from a cohort study and the Health Insurance Review and Assessment Service database, we conducted a cost-effectiveness analysis comparing sevelamer with calcium acetate in dialysis patients from the perspective of the National Health Insurance Service in South Korea.
  
  
  
  Data (demographic, diagnostic, laboratory, and survival) from 4674 patients undergoing dialysis enrolled in a multicenter prospective cohort study conducted in South Korea between September 2008 and December 2012 were linked to phosphate binder use, hospitalization, and cost data available from the Health Insurance Review and Assessment Service database. After propensity score matching, a dataset comprising comparable patients treated with either sevelamer (n = 501) or calcium acetate (n = 501) was used in the cost-effectiveness analysis. A Markov model was used to estimate costs, life years, quality-adjusted life years (QALYs), and cost-effectiveness over each patient's lifetime. Forty-month treatment-specific overall survival (OS) data available from the dataset were extrapolated to lifetime survival with the use of regression analysis.
  
  
  
  Patients had a mean age of 56.3 years and were treated with dialysis for a mean duration of 67.6 months. Compared with calcium acetate, sevelamer was associated with an incremental cost of South Korean Won (₩) 12,246,911 ($10,819) and a gain of 1.758 life years and 1.108 QALYs per patient. This outcome yielded incremental cost-effectiveness ratios of ₩6,966,350 ($6154) and ₩11,057,699 ($9768) per life year and QALY gained, respectively. Conclusions regarding sevelamer's cost-effectiveness were insensitive to alternative assumptions in time horizon, discount rate, hospitalization rate, costs, and health utility estimates, and they remained consistent in 100% of the model iterations, considering a willingness-to-pay threshold of ₩31,894,720 ($28,176) per QALY gained.
  
  
  
  This analysis of real-world data found that sevelamer's higher cost relative to calcium acetate was adequately offset by improved survival among patients undergoing dialysis in South Korea. As such, sevelamer offers good value for money, representing a cost-effective alternative to calcium-based binders.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Jang-Hee
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Statistics, Kyungpook National University, Daegu, South Korea.
authors.forename: Hye Min
authors.initials: HM
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Hee-Yeon
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Ji-Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea.
authors.forename: Chan-Duck
authors.initials: CD
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul St. Mary׳s Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, South Korea.
authors.forename: Dong-Chan
authors.initials: DC
authors.lastname: Jin
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea; BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu, South Korea; Cell and Matrix Research Institute, Kyungpook National University, Daegu, South Korea. Electronic address: ylkim@knu.ac.kr.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
mesh_terms: D000085:Acetates / Q000191:economics* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D044466:Asian People; D017610:Calcium Compounds / Q000191:economics / Q000627:therapeutic use; D002614:Chelating Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009313:National Health Programs; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000191:economics* / Q000628:therapy; D056910:Republic of Korea; D000069603:Sevelamer / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000085:Acetates; D017610:Calcium Compounds; D002614:Chelating Agents; D000069603:Sevelamer; C120662:calcium acetate
keywords: calcium acetate; cost-effectiveness; dialysis; sevelamer