Cost-Effectiveness of Lanthanum Carbonate in the Treatment of Hyperphosphatemia in Chronic Kidney Disease Before and During Dialysis

Abstract

Objectives: Hyperphosphatemia is a common and harmful condition in patients with chronic kidney disease (CKD). We determined the costeffectiveness of the noncalcium-based phosphate binder lanthanum carbonate (LC) as second-line treatment of hyperphosphatemia after therapy failure with calcium-based binders (CB). Methods: Two CKD populations were modeled: 1) predialysis CKD patients and 2) incident dialysis patients. Patients not responding to CB with a serum phosphate (SP) level Ͼ5.5 mg/dl received a trial with LC. Patients not responding to LC (SP Ͼ4.6 mg/dl) returned to CB treatment. Patient-level data were obtained from clinical trials in predialysis and dialysis. Timedependent, life-long Markov models (discounting at 3.5% annually) were developed, using a UK National Health Service perspective. Results: The health gains with second-line LC treatment compared to CB treatment were 44 and 56 quality-adjusted life-years (QALYs) for the predialysis and incident dialysis populations, respectively. Second-line LC was a cost-saving strategy in the predialysis population because of the cost-savings of delayed CKD progression. Second-line LC was costeffective at £6900 (90% probability interval: £5800 -£8300) per QALY gained in the dialysis population. Results were robust to plausible variations in other model parameters; inclusion of future unrelated dialysis costs had a large influence on cost-effectiveness estimates. Conclusions: Second-line treatment with LC is associated with considerable clinical benefits and good value for money in CKD, irrespective of dialysis status. These results support Kidney Disease Outcomes Quality Initiative guidelines to treat CKD patients with hyperphosphatemia irrespective of dialysis status.

Cost-Minimization Analysis of Lanthanum Carbonate Versus Sevelamer Hydrochloride in US Patients With End-stage Renal Disease

“…In addition, several other economic evaluations have demonstrated the cost-effectiveness of lanthanum carbonate as second-line treatment for hyperphosphatemia from UK, US, Canadian, Japanese, and Australian payer perspectives. 22,24,[33][34][35] The primary limitations of the present evaluation are those inherent to post hoc analyses of clinical data. 36 A limitation common to health economic analyses is that although ESRD and hyperphosphatemia are chronic conditions, our analyses of the comparative cost-effectiveness of sevelamer hydrochloride and lanthanum carbonate were limited to a relatively short duration (16 weeks).…”

Real-World Dose-Relativity, Tablet Burden, and Cost Comparison of Conversion Between Sevelamer Hydrochloride/Carbonate and Lanthanum Carbonate Monotherapies

“…21,22 The results of the cost analyses presented here are consistent with previous economic evaluations demonstrating the cost-effectiveness of lanthanum carbonate as second-line treatment for hyperphosphatemia from Australian, Canadian, Japanese, UK, and US payer perspectives. [30][31][32][33][34] Several limitations of the study should be noted. These analyses were limited to patients enrolled in the LDO's pharmacy management program.…”

Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis

“…A decision analytic model and Markov modeling techniques previously designed [14] were used to simulate the progression of a hypothetical cohort of 1,000 Spanish patients who are initially not on dialysis, representing the relevant stages of the natural history of the disease over time, as well as estimates for probability of progression between the health states related to CKD. All parameters of the model are summarized in Table 1.…”

“…Prolonged dialysis care is related to the extended life of treated patients rather than to phosphate binder choice [31,32]. Dialysis costs in the added life years were classified as unrelated future costs and in line with previous cost-effectiveness analysis [14] were not included in the base case, but explored in sensitivity analysis.…”

“…Cost-effectiveness of LC in second line treatment after CB has also been evaluated in predialysis from a UK perspective [14]. …”