A Real-world Cost-effectiveness Analysis of Sevelamer Versus Calcium Acetate in Korean Dialysis Patients

Yoo

et al. 2018

Kidney Res Clin Pract.

Self Cite

BackgroundWe investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients.MethodsAmong hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed.ResultsAmong 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71–0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20–1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08–1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02–1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05–1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12–1.67; P = 0.003).ConclusionIn Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.

Section: Discussionmentioning

confidence: 99%

Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry

Yoo

et al. 2018

Kidney Res Clin Pract.

Self Cite

“…Most studies used Markov models ( N = 18 [ 47 , 48 , 50 – 60 , 63 – 67 ]) and were evaluated over a patient’s lifetime ( N = 21 [ 47 – 49 , 51 – 62 , 64 – 69 ]). Nineteen [ 48 – 53 , 60 – 70 ] and eight studies [ 47 , 54 – 59 , 71 ] focused on dialysis and pre-dialysis patients, respectively. The majority of studies accounted for dialysis costs in their analyses, although 9 studies failed to do so [ 48 – 50 , 63 – 66 , 68 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of the cost-utility of phosphate binders as a treatment option for hyperphosphatemia in chronic kidney disease patients: a systematic review and meta-analysis of the economic evaluations

et al. 2021

Background Uncontrolled hyperphosphatemia in chronic kidney disease (CKD) patients commonly results in vascular calcification leading to increased risk of cardiovascular disease. Phosphate binders (PBs) are used for hyperphosphatemia and can be calcium-based (CBPBs) or non-calcium-based (NCBPBs), the latter being more expensive than CBPBs. In this study, we used meta-analysis approaches to assess the cost-utility of PBs for hyperphosphatemia in CKD patients. Methods Relevant studies published prior to June 2019 were identified from PubMed, Scopus, the Cochrane Library, the National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Studies were eligible if they included CKD patients with hyperphosphatemia, compared any PBs and reported economic outcomes. Meta-analysis was applied to pool incremental net benefit (INB) across studies stratified by country income. Results A total of 25 studies encompassing 32 comparisons were eligible. Lanthanum carbonate, a NCBPB, was a more cost-effective option than CBPBs in high-income countries (HICs), with a pooled INB of $3984.4 (599.5–7369.4), especially in pre-dialysis patients and used as a second-line option with INBs of $4860.2 (641.5–9078.8), $4011.0 (533.7–7488.3), respectively. Sevelamer, also a NCBPB, was not more cost-effective as a first-line option compared to CBPBs with a pooled INB of $6045.8 (− 23,453.0 to 35,522.6) and $34,168.9 (− 638.0 to 68,975.7) in HICs and upper middle-income countries, respectively. Conclusions Lanthanum carbonate was significantly more cost-effective than CBPBs as a second-line option for hyperphosphatemia in pre-dialysis patients in HICs. However, the use of sevelamer is not more cost-effective as a first-line option compared to CBPBs.

“…Одно из исследований показывает, что гораздо более эффективный, но более дорогой севеламер все равно предпочтительнее в финансовом плане, чем дешевые препараты кальция, так как его при-менение минимизирует риски осложнений и, со-ответственно, связанных с ними затрат и в целом сопровождается более высокими показателями вы-живаемости [16].…”

Section: To Help the Practitionerunclassified

Медикаментозная Коррекция Нарушений Фосфатно-Кальциевого Обмена У Пациентов С Хронической Болезнью Почек И Минерально-Костной Болезнью

Dombrovsky¹,

Ivanovа²,

Иванов³

2021

KIDNEYS

Нарушения фосфатно-кальциевого обмена часто наблюдаются у пациентов с хронической болезнью почек и являются основным патогенетическим фактором в развитии вторичного гиперпаратиреоза и минерально-костной болезни в этой группе пациентов. Основная часть данной статьи посвящена препаратам для медикаментозной терапии данной патологии, в частности таким лекарственным средствам, как севеламер и цинакальцет.