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

AIMS: In Spain, the first line treatment of hyperphosphatemia in Chronic Kidney Disease (CKD) consists of calcium-based phosphate binders (CB). However, their use is associated with vascular calcification and an increased mortality risk. The aim of this study was to assess the incremental cost-effec...

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Autores principales: Gros, Blanca, Galán, Antonio, González-Parra, Emilio, Herrero, Jose A, Echave, Maria, Vegter, Stefan, Tolley, Keith, Oyagüez, Itziar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467815/
https://www.ncbi.nlm.nih.gov/pubmed/26062537
http://dx.doi.org/10.1186/s13561-015-0049-3
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author Gros, Blanca
Galán, Antonio
González-Parra, Emilio
Herrero, Jose A
Echave, Maria
Vegter, Stefan
Tolley, Keith
Oyagüez, Itziar
author_facet Gros, Blanca
Galán, Antonio
González-Parra, Emilio
Herrero, Jose A
Echave, Maria
Vegter, Stefan
Tolley, Keith
Oyagüez, Itziar
author_sort Gros, Blanca
collection PubMed
description AIMS: In Spain, the first line treatment of hyperphosphatemia in Chronic Kidney Disease (CKD) consists of calcium-based phosphate binders (CB). However, their use is associated with vascular calcification and an increased mortality risk. The aim of this study was to assess the incremental cost-effectiveness of second-line Lanthanum Carbonate (LC) treatment in patients not responding to CB (calcium carbonate and calcium acetate). MATERIAL AND METHODS: A lifetime Markov model was developed considering three health states (predialysis, dialysis and death). Transitions between states and efficacy data were obtained from randomized clinical trials and the European Dialysis and Transplant Association Annual report. Mortality rate was adjusted with the relative risk related to serum phosphorus levels. According to the Spanish healthcare system perspective, only medical direct costs were considered. Dialysis costs (2013 prices in Euros) were obtained from diagnosis-related groups. Drug costs were derived from ex-factory prices, adjusted with 7.5% mandatory rebate. Quality of life estimates were based on a published systematic review. Costs and benefits were discounted at 3%. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. RESULTS: At the end of simulation, costs per patient with LC therapy were €1,169 and €5,044 with CB alone. 4.653 Quality Adjusted Life Years (QALYs) were gained per patient treated with LC, and 4.579 QALYs with CB. CB therapy is dominated by the LC strategy (i.e. lower costs, higher QALYs). Assuming a €30,000/QALY threshold, LC was dominant in 100% of PSA simulations. CONCLUSIONS: LC is a cost-effective second line treatment of hyperphosphatemia in CKD patients irrespective of dialysis status in Spain.
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spelling pubmed-44678152015-06-18 Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis Gros, Blanca Galán, Antonio González-Parra, Emilio Herrero, Jose A Echave, Maria Vegter, Stefan Tolley, Keith Oyagüez, Itziar Health Econ Rev Research AIMS: In Spain, the first line treatment of hyperphosphatemia in Chronic Kidney Disease (CKD) consists of calcium-based phosphate binders (CB). However, their use is associated with vascular calcification and an increased mortality risk. The aim of this study was to assess the incremental cost-effectiveness of second-line Lanthanum Carbonate (LC) treatment in patients not responding to CB (calcium carbonate and calcium acetate). MATERIAL AND METHODS: A lifetime Markov model was developed considering three health states (predialysis, dialysis and death). Transitions between states and efficacy data were obtained from randomized clinical trials and the European Dialysis and Transplant Association Annual report. Mortality rate was adjusted with the relative risk related to serum phosphorus levels. According to the Spanish healthcare system perspective, only medical direct costs were considered. Dialysis costs (2013 prices in Euros) were obtained from diagnosis-related groups. Drug costs were derived from ex-factory prices, adjusted with 7.5% mandatory rebate. Quality of life estimates were based on a published systematic review. Costs and benefits were discounted at 3%. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. RESULTS: At the end of simulation, costs per patient with LC therapy were €1,169 and €5,044 with CB alone. 4.653 Quality Adjusted Life Years (QALYs) were gained per patient treated with LC, and 4.579 QALYs with CB. CB therapy is dominated by the LC strategy (i.e. lower costs, higher QALYs). Assuming a €30,000/QALY threshold, LC was dominant in 100% of PSA simulations. CONCLUSIONS: LC is a cost-effective second line treatment of hyperphosphatemia in CKD patients irrespective of dialysis status in Spain. Springer Berlin Heidelberg 2015-06-11 /pmc/articles/PMC4467815/ /pubmed/26062537 http://dx.doi.org/10.1186/s13561-015-0049-3 Text en © Gros et al. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Research
Gros, Blanca
Galán, Antonio
González-Parra, Emilio
Herrero, Jose A
Echave, Maria
Vegter, Stefan
Tolley, Keith
Oyagüez, Itziar
Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title_full Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title_fullStr Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title_full_unstemmed Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title_short Cost effectiveness of lanthanum carbonate in chronic kidney disease patients in Spain before and during dialysis
title_sort cost effectiveness of lanthanum carbonate in chronic kidney disease patients in spain before and during dialysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467815/
https://www.ncbi.nlm.nih.gov/pubmed/26062537
http://dx.doi.org/10.1186/s13561-015-0049-3
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