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Cost-Effectiveness Analysis for the Treatment of Hyperphosphatemia in Predialysis Patients: Calcium-Based versus

B L Goh1, A Soraya2, A Goh2

  • 1Clinical Research Centre, Serdang Hospital, Kajang 43000, Malaysia.

International Journal of Nephrology
|October 18, 2018
PubMed

Insights

Sevelamer is a cost-effective alternative to calcium carbonate for managing hyperphosphatemia in Malaysian chronic kidney disease (CKD) patients, offering improved life years and quality-adjusted life years (QALYs). This finding supports its use, especially for patients with high calcium loads.

Area of Science:

  • Nephrology
  • Health Economics
  • Pharmacoeconomics

Background:

  • Hyperphosphatemia is common in chronic kidney disease (CKD).
  • Calcium carbonate (CaCO3) is a common treatment but increases calcium load and cardiovascular risk.
  • Non-calcium phosphate binders are alternatives but are more expensive.

Purpose of the Study:

  • To analyze the cost-effectiveness of sevelamer versus CaCO3.
  • To evaluate treatment for hyperphosphatemia in stage III-V predialysis CKD patients in Malaysia.

Main Methods:

  • A Markov decision model simulated a cohort of CKD patients.
  • Survival data from the INDEPENDENT-CKD trial was used.
  • Malaysian cost data and literature-derived utilities were incorporated.

Main Results:

  • Sevelamer yielded 6.37 life years (5.27 QALYs) vs. 4.25 life years (3.54 QALYs) with CaCO3.
  • Lifetime costs were higher for sevelamer (RM159,901) than CaCO3 (RM77,139).
  • The incremental cost-effectiveness ratio (ICER) for sevelamer was RM47,679 per QALY, below the WHO threshold.

Conclusions:

  • Sevelamer is potentially cost-effective compared to CaCO3 for predialysis CKD patients in Malaysia.
  • Sevelamer offers improved survival and quality-adjusted life years.
  • The study recommends sevelamer as a treatment option, particularly for patients with high calcium loads.
Abstract

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