Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia

Abstract

Because of an elevated serum phosphate level, patients who suffer from chronic kidney failure frequently tend to have cardiovascular calcification and are therefore exposed to a higher probability of a fatal event. Phosphate binders are able to reduce these negative effects. Currently, there are primarily two groups of phosphate binders (calcium-containing and calcium-free phosphate binders) which are considered to be almost equally effective in terms of binding of free phosphate. There are, however, a few disadvantages of the two groups. While the calcium-containing binders are associated with an increased risk of hypercalcemia, which is dose dependent, calcium-free binders have been criticized as being too expensive. As the expenditure for patients suffering from chronic kidney failure increases from year to year, as a result of increasing prevalence, there is a growing need for an alternative to existing phosphate binders. The study presented here therefore summarizes available information for the novel combination preparation OsvaRen® (calcium acetate/magnesium carbonate) as an alternative therapy to the calcium-free phosphate binder Renagel® (sevelamer-hydrochloride) and to calcium-containing preparations.The results of this systematic review showed that OsvaRen® is at least equally effective in the regulation of serum phosphate level as Renagel®. In particular, OsvaRen® shows no clinically relevant difference in terms of the control of the serum calcium levels compared to Renagel® and thereby does not increase the risk of a hypercalcaemia, in contrast to pure calcium-based phosphate binders. On the other hand, Renagel® therapy is much more frequently associated with gastrointestinal side-effects, a tendency to result in higher tablet burden for patients and high medication costs. The CALMAG study showed that OsvaRen® was at least as effective and safe in terms of controlling serum phosphate and serum calcium levels as Renagel® while, at the same time, resulting in about 80% lower costs. In addition, OsvaRen® offers a lower risk of hypercalcaemia and associated subsequent costs and is thereby also superior to pure calcium-containing phosphate binders.Because of the effectiveness and tolerability of calcium acetate/magnesium carbonate, OsvaRen® offers a clinically suitable and, at the same time, cost-effective therapeutic option in the therapy of hyperphosphataemia.

Cobenefits of Replacing Car Trips with Alternative Transportation: A Review of Evidence and Methodological Issues

“…Active transport such as walking and cycling provides an opportunity to incorporate frequent physical activity into daily living, which could help people achieve recommended levels of physical activity. Moreover, various evidence of a positive association between active transport and health outcomes has been published [20, 47–51]. For example, a recent systematic review [52] summarised evidence of the health benefits of cycling and reported a strong inverse relationship between commuter cycling and all-cause mortality, cardiorespiratory fitness, cancer mortality and morbidity, and a clear positive dose-response relationship between the amount of cycling and body fitness, and incidence of overweight and obesity decrease.…”

Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review

“…In these reviews, however, the cost‐effectiveness of first‐line sevelamer and that of LC versus sevelamer were not established . CA combined with magnesium carbonate was suggested by Plagemann et al . as a cost‐effective first‐line therapy.…”

“…as a cost‐effective first‐line therapy. However, this review did not include any full economic evaluation of this combination and was funded by the pharmaceutical industry. None of these reviews adopted a systematic methodology or critically appraised the quality of included studies.…”

“…10 Several reviews in this field were previously conducted. [11][12][13] Komaba et al 11 and Goto et al 12 suggested LC as a cost-effective second-line therapy, especially in patients with moderate to severe hyperphosphataemia. In these reviews, however, the cost-effectiveness of first-line sevelamer and that of LC versus sevelamer were not established.…”

“…In these reviews, however, the cost-effectiveness of first-line sevelamer and that of LC versus sevelamer were not established. 11,12 CA combined with magnesium carbonate was suggested by Plagemann et al 13 as a cost-effective first-line therapy. However, this review 13 did not include any full economic evaluation of this combination and was funded by the pharmaceutical industry.…”