Objectives: Worldwide, incidence rates of chronic renal insufficiency have clearly increased over the past decade, especially in people of older age. Hyperphosphatemia is the strongest independent risk factor for mortality in renal patients. In order to reduce serum phosphate concentrations to recommended values, phosphate binders (P binders) are used to bind ingested phosphate in the digestive tract. Besides the traditional therapies with calcium and aluminium salts, sevelamer and lanthanum represent recent developments on the market. The purpose of the present health technology assessment (HTA) report was to compare the effectiveness and safety of different P binders in patients with chronic renal insufficiency. Methods: Based on a systematic literature search followed by a two-part selection process with predefined criteria 18 publications were included in the assessment. Results: All P binders effectively controlled serum phosphate, calcium and parathyroid hormone concentrations. The numbers of hypercalcemic episodes were higher when using calcium-containing P binders compared to sevelamer and lanthanum. Regarding mortality rate, cardiovascular calcification and bone metabolism no definite conclusions could be drawn; however, sevelamer seemed to be more effective than calcium in certain patient subgroups, such as older patients and patients with preexisting arterial calcification. Conclusions: From a medical point of view, sevelamer showed superiority over calcium-containing P binders at least for special indications.

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Issue/problem The Austrian health care system regularly shows high performance. While about 99.9% of the population is covered by the compulsory health insurance system, the system is highly fragmented with shared responsibilities for inpatient and outpatient care. Description of the problem Primary health care in Austria is mainly provided by general practitioners (GP) in solo practises with average opening hours of 16-20 hours a week. This leads to high frequencies in outpatient care departments of hospitals and secondly to inefficiencies due to a high level of uncoordinated care. Thus in June 2014, the Federal Target-Based Governance Commission adopted a new concept for providing primary Health Care in an integrative, quality-assured manner and steering patients to the Best Point of Service. PHC centres are providing care in a multiprofessional approach (psychologists, nutritionists, and nurses) and have significantly longer opening hours with 45 hours per week. Results In 2015, the State Target-Based Governance Commission of Vienna commissioned the Austrian Public Health Institute (Gesundheit Österreich GmbH) with the evaluation of these pilot centers. The evaluation results of the first two years of the first PHC center shows a high level of satisfaction with the services provided by PHC and high level of utilisation, indicating an improvement in the service offered. PHC patients show a significantly higher level of utilisation of general medical care and at the same time a lower level of utilisation of specialist medical care than patients of the control group. Furthermore PHC patients have a significantly lower frequency of contacts in general emergency outpatient clinics. Lessons Changes in structural conditions such as the expansion in the range of services and the provision of care by a multiprofessional team results in advantages for patients, the team and the utilization of services at the best point of service. Key messages PHC centers can lead to a lower utilization of outpatient departments and thus to an improvement in the coordination of care. Cooperation in multi-professional teams can lead to a relief of the physicians and a higher job satisfaction.