Effectiveness and Cost-Efficacy of Phosphate Binders in Hemodialysis

Abstract

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.

Efficacy and safety of lanthanum carbonate on chronic kidney disease–mineral and bone disorder in dialysis patients: a systematic review

“…Although LC can reduce the serum phosphorus level and has a lower risk of vascular calcification and hypercalcemia, it is a rare metal that is more valuable than calcium. A number of studies focused on the cost-effectiveness ratio of phosphate binders [61,62]. One study [61] showed that LC is cost-effective as a second-line treatment for patients who are not adequately maintained on CC (serum phosphorus above 5.6 mg/dL).…”

Phosphate Control in Peritoneal Dialysis Patients: Issues, Solutions, and Open Questions

“…The latest Cochrane meta-analysis performed on the treatment of hyperphosphatemia in patients with any stage of CKD showed no clear and absolute advantages of calcium-free phosphate binders on different clinical outcomes compared to calcium-containing compounds [ 66 ]. In the absence of unequivocal benefits of one phosphate binder over another, in a context where health expenditure is already very high, caution is recommended when using noncalcium-based compounds for which the cost/benefit ratio is unfavorable and whose use should be preferred in particular situations (hypercalcemia, presence of widespread vascular calcifications) [ 67 ].…”