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

Keith, Michael; Wilson, Rosamund; Preston, Peter; Copley, John B.

doi:10.1016/j.clinthera.2014.06.036

Cited by 14 publications

(12 citation statements)

References 25 publications

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“…Filiopoulos et al [31] compared sevelamer hydrochloride and LC in patients on hemodialysis and found a beneficial effect of switching from sevelamer hydrochloride to LC in terms of reducing metabolic acidosis and hyperkalemia. Moreover, several studies have shown that switching from sevelamer to LC could reduce drug costs and tablet burden while maintaining serum phosphate levels within the normal range [32, 33]. Unfortunately, there were not enough RCTs available to compare these parameters between the various phosphate binders individually.…”

Section: Discussionmentioning

confidence: 99%

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Hyperphosphatemia is common in patients on hemodialysis. The efficacy of lanthanum carbonate (LC) in the treatment of hyperphosphatemia in these patients remains controversial. The objective of this meta-analysis was to evaluate the effect of LC on all-cause mortality in patients on maintenance hemodialysis. Methods: We electronically searched the PubMed, EMBASE, and Cochrane Library databases for all randomized controlled trials (RCTs) comparing LC with other phosphate binders used in adult hemodialysis patients, including calcium carbonate, calcium acetate, and sevelamer. Results: Nine RCTs involving 2813 patients were suitable for inclusion. Our results showed that all-cause mortality was significantly lower in patients who received LC than in those who received standard therapy (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.32–0.63, P<0.00001). Compared with the controls, patients who received LC had significantly lower serum calcium and higher serum intact parathyroid hormone levels. However, there was no significant difference between the groups in the cardiovascular event rate (OR: 0.58, 95% CI: 0.31–1.06, P=0.07) or in serum phosphorus levels. Conclusion: Compared with standard therapy, LC reduced all-cause mortality in patients on hemodialysis but did not decrease the risk of cardiovascular events. The decrease in serum phosphorus level was similar between LC and the other phosphate binders, but the risk of hypercalcemia was lower in patients who received LC.

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Section: Discussionmentioning

confidence: 99%

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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“…For end-stage renal disease patients, higher doses over time are often required as the disease progresses. Therefore, dosage of sevelamer for these patients was set to be 2.4 g/day in the first year, 4.8 g/day in years 2–4, 7.2 g/day in years 5–7, and 9.6 g/day from year 8 onwards [ 15 ]. Due to the lack of data on changes in dosage over time for patients on calcium carbonate and because of its very low cost relative to sevelamer, we assumed a constant dose (2.95 g/day).…”

Section: Methodsmentioning

confidence: 99%

Incremental cost-utility of sevelamer relative to calcium carbonate for treatment of hyperphosphatemia among pre-dialysis chronic kidney disease patients

2016

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BackgroundSevelamer is an alternative to calcium carbonate for the treatment of hyperphosphatemia among non-dialysis dependent patients with chronic kidney disease (CKD). Although some studies show that it may reduce mortality and delay the onset of dialysis when compared to calcium carbonate, it is also significantly more expensive. Prior studies looking at the incremental cost-effectiveness of sevelamer versus calcium carbonate in pre-dialysis patients are based on data from a single clinical trial. The goal of our study is to use a wider range of clinical data to achieve a more contemporary and robust cost-effectiveness analysis.MethodsWe used a Markov model to estimate the lifetime costs and quality-adjusted life years (QALYs) gained for treatment with sevelamer versus calcium carbonate. The model simulated transitions among three health states (CKD not requiring dialysis, end-stage renal disease, and death). Data on transition probabilities and utilities were obtained from the published literature. Costs were calculated from a third party payer perspective and included medication, hospitalization, and dialysis. Sensitivity analyses were also run to encompass a wide range of assumptions about the dose, costs, and effectiveness of sevelamer.ResultsOver a lifetime, the average cost per patient treated with sevelamer is S$180,724. The estimated cost for patients treated with calcium carbonate is S$152,988. A patient treated with sevelamer gains, on average, 6.34 QALYs relative to no treatment, whereas a patient taking calcium carbonate gains 5.81 QALYs. Therefore, sevelamer produces an incremental cost-effectiveness ratio (ICER) of S$51,756 per QALY gained relative to calcium carbonate.ConclusionBased on established benchmarks for cost-effectiveness, sevelamer is cost effective relative to calcium carbonate for the treatment of hyperphosphatemia among patients with chronic kidney disease initially not on dialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0256-0) contains supplementary material, which is available to authorized users.

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“…None of the trials on LC reported any effect on inflammation or inflammatory biomarkers. Although LC is cheaper and more compliant compared to sevelamer [127], our target is not just to control phosphorus level. Sevelamer compounds have got more comprehensive trials that showed significant impact on patient mortality during predialysis stages and in incident HD.…”

Section: Management Of Non-traditional Risk Factorsmentioning

confidence: 99%

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

2016

J Urol Nephrol

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Chronic kidney disease (CKD) patients have the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the mortalities, with cardiovascular calcifications affecting the majority of those CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 (FGF23) and Klotho were incriminated in the pathogenesis of vascular calcification (VC) through different mechanisms including their effect on endothelium and arterial wall smooth muscle cells. In addition, deficient Klotho gene expression is a constant feature in CKD patients. This deficiency, not only promotes vascular pathology, but also has a role in the progression of the CKD. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, diagnostic tools, the ideal timing to prevent or to withhold the progression of VC and the different medications and medical procedures that can help to prolong the survival of CKD patients. IntroductionThe problematic increase of cardiovascular morbidity and mortality is behind the increased interest in VC among CKD patients. VC is a strong predictor of increased cardiovascular mortality among CKD patients. However, almost all of the clinical studies that have tried to manipulate the various risk factors for VC in dialysis patients have failed to show a significant impact on patient survival. On the other hand, when pre-dialysis patients underwent similar studies, there was a significant decrease in cardiovascular and overall mortality rates, as well as a comparable effect on VC progress rate. These results point toward the importance of early intervention. The ideal timing and dynamics of this intervention will be thoroughly discussed. VC In CKD PatientsThe prevalence of VC among pre-dialysis CKD G3-5 patients is 79% as reported in a recent study [1]. It might approach 100% in patients starting dialysis [2]. Upto 3-4 fold increase in VC has been reported in the earliest phases of CKD [3].VC in CKD can affect the tunica intima and/or the tunica media layers. Intimal calcification is mainly a feature of atherosclerosis [4]. Medial calcification is restricted to CKD and is encountered even at young ages [5,6]. Hemodialysis (HD) patients have higher calcification scores than both peritoneal dialysis (PD) and CKD G4 patients. More heavily calcified patients were significantly older and mostly male [7]. In HD patients, coronary calcification progresses steadily [8]. High serum phosphate concentration was a strong independent risk factor only in non-diabetic patients. Diabetic patients lack similar associations [9]. Patients starting dialysis at the age of 25-29 years have an expected survival 33 years less than the general populous. Arterial calcification is one of the predictors of this increased cardiovascular mortality [10].The prevalence of coronary artery calcification (CAC) in kidney transplant recipients (KTRs) is higher (61-75%) than that assessed in CKD G3, [11,12] and lower than tha...

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

Cited by 14 publications

References 25 publications

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials

Incremental cost-utility of sevelamer relative to calcium carbonate for treatment of hyperphosphatemia among pre-dialysis chronic kidney disease patients

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

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