Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Nephrology
Published in: Journal of Nephrology 5/2015

01-10-2015 | Original Article

Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study

Authors: Matteo Ruggeri, Antonio Bellasi, Filippo Cipriani, Donald Molony, Cynthia Bell, Domenico Russo, Biagio Di Iorio

Published in: Journal of Nephrology | Issue 5/2015

Login to get access

Abstract

Background

The recent multicenter, randomized, open-label INDEPENDENT study demonstrated that sevelamer improves survival in new to hemodialysis (HD) patients compared with calcium carbonate. The objective of this study was to determine the cost-effectiveness of sevelamer versus calcium carbonate for patients new to HD, using patient-level data from the INDEPENDENT study.

Study design

Cost-effectiveness analysis.

Setting and population

Adult patients new to HD in Italy.

Model, perspective, timeframe

A patient-level cost-effectiveness analysis was conducted from the perspective of the Servizio Sanitario Nazionale, Italy’s national health service. The analysis was conducted for a 3-year time horizon. The cost of dialysis was excluded from the base case analysis.

Intervention

Sevelamer was compared to calcium carbonate.

Outcomes

Total life years (LYs), total costs, and the incremental cost per LY gained were calculated. Bootstrapping was used to estimate confidence intervals around LYs, costs, and cost-effectiveness and to calculate the cost-effectiveness acceptability curve.

Results

Sevelamer was associated with a gain of 0.26 in LYs compared to calcium carbonate, over the 3-year time horizon. Total drug costs were €3,282 higher for sevelamer versus calcium carbonate, while total hospitalization costs were €2,020 lower for sevelamer versus calcium carbonate. The total incremental cost of sevelamer versus calcium carbonate was €1,262, resulting in a cost per LY gained of €4,897. The bootstrap analysis demonstrated that sevelamer was cost effective compared with calcium carbonate in 99.4 % of 10,000 bootstrap replicates, assuming a willingness-to-pay threshold of €20,000 per LY gained.

Limitations

Data on hospitalizations was taken from a post hoc retrospective chart review of the patients included in the INDEPENDENT study. Patient quality of life or health utility was not included in the analysis.

Conclusions

Sevelamer is a cost-effective alternative to calcium carbonate for the first-line treatment of hyperphosphatemia in new to HD patients in Italy.
Appendix
Available only for authorised users
Literature
1.
2.
Ghosh B, Brojen T, Banerjee S et al (2012) The high prevalence of chronic kidney disease-mineral bone disorders: a hospital-based cross-sectional study. Indian J Nephrol 22(4):285–291PubMedCentralCrossRefPubMed
3.
Kong X, Zhang L, Zhang L et al (2012) Mineral and bone disorder in Chinese dialysis patients: a multicenter study. BMC Nephrol 21:13–116
4.
Fernández-Martín JL, Carrero JJ, Benedik M et al (2013) COSMOS: the dialysis scenario of CKD-MBD in Europe. Nephrol Dial Transplant 28(7):1922–1935CrossRefPubMed
5.
Gonzalez-Parra E, Tunon J, Egido J, Ortiz A (2012) Phosphate: a stealthier killer than previously thought? Cardiovasc Pathol 21(5):372–381CrossRefPubMed
6.
7.
Kidney Disease: Improving Global Outcomes (KDIGO) (2009) KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 76(Suppl 113):S1–S130
8.
Goodman WG, Goldin J, Kuizon BD et al (2000) Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 342(20):1478–1483CrossRefPubMed
9.
Guerin AP, London GM, Marchais SJ, Metivier F (2000) Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 15(7):1014–1021CrossRefPubMed
10.
Bushinsky DA (2010) Contribution of intestine, bone, kidney, and dialysis to extracellular fluid calcium content. Clin J Am Soc Nephrol 5(Suppl 1):S12–S22CrossRefPubMed
11.
Hsu CW, Lin JL, Lin-Tan DT et al (2010) High-calcium dialysate: a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. Nephrology (Carlton) 15(3):313–320CrossRef
12.
Spiegel DM, Brady K (2012) Calcium balance in normal individuals and in patients with chronic kidney disease on low- and high-calcium diets. Kidney Int 81(11):1116–1122PubMedCentralCrossRefPubMed
13.
Hill KM, Martin BR, Wastney ME et al (2013) Oral calcium carbonate affects calcium but not phosphorus balance in stage 3–4 chronic kidney disease. Kidney Int 83(5):959–966PubMedCentralCrossRefPubMed
14.
Chertow GM, Burke SK, Raggi P (2002) Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 62(1):245–252CrossRefPubMed
15.
Chertow GM, Raggi P, McCarthy JT et al (2003) The effects of sevelamer and calcium acetate on proxies of atherosclerotic and arteriosclerotic vascular disease in hemodialysis patients. Am J Nephrol 23(5):307–314CrossRefPubMed
16.
Braun J, Asmus HG, Holzer H et al (2004) Long-term comparison of a calcium-free phosphate binder and calcium carbonate–phosphorus metabolism and cardiovascular calcification. Clin Nephrol 62(2):104–115CrossRefPubMed
17.
Asmus HG, Braun J, Krause R et al (2005) Two year comparison of sevelamer and calcium carbonate effects on cardiovascular calcification and bone density. Nephrol Dial Transplant 20(8):1653–1661CrossRefPubMed
18.
Takei T, Otsubo S, Uchida K et al (2008) Effects of sevelamer on the progression of vascular calcification in patients on chronic haemodialysis. Nephron Clin Pract 108(4):c278–c283CrossRefPubMed
19.
Shantouf R, Ahmadi N, Flores F et al (2010) Impact of phosphate binder type on coronary artery calcification in hemodialysis patients. Clin Nephrol 74(1):12–18CrossRefPubMed
20.
Kakuta T, Tanaka R, Hyodo T et al (2011) Effect of sevelamer and calcium-based phosphate binders on coronary artery calcification and accumulation of circulating advanced glycation end products in hemodialysis patients. Am J Kidney Dis 57(3):422–431CrossRefPubMed
21.
Di Iorio BR, Cucciniello E, Bellizzi V (2009) Vascular calcification and QT interval in incident hemodialysis patients. J Nephrol 22(6):694–698PubMed
22.
Block GA, Spiegel DM, Ehrlich J et al (2005) Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Kidney Int 68(4):1815–1824CrossRefPubMed
23.
Block GA, Raggi P, Bellasi A, Kooienga L, Spiegel DM (2007) Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients. Kidney Int 71(5):438–441CrossRefPubMed
24.
Di Iorio B, Molony D, Bell C et al (2013) Sevelamer versus calcium carbonate in incident hemodialysis patients: results of an open-label 24-month randomized clinical trial. Am J Kidney Dis 62(4):771–778CrossRefPubMed
25.
Suki WN, Zabaneh R, Cangiano JL et al (2007) Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Kidney Int 72(9):1130–1137CrossRefPubMed
26.
Suki WN (2008) Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients: results of a randomized clinical trial. J Ren Nutr 18(1):91–98CrossRefPubMed
27.
Grima DT, Bernard LM, Dunn ES, McFarlane PA, Mendelssohn DC (2012) Cost-effectiveness analysis of therapies for chronic kidney disease patients on dialysis: a case for excluding dialysis costs. Pharmacoeconomics 30(11):981–989CrossRefPubMed
28.
London GM (2003) Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 18(9):1731–1740CrossRefPubMed
29.
St Peter WL, Liu J, Weinhandl E, Fan Q (2008) A comparison of sevelamer and calcium-based phosphate binders on mortality, hospitalization, and morbidity in hemodialysis: a secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) randomized trial using claims data. Am J Kidney Dis 51(3):445–454CrossRefPubMed
30.
Briggs AH, Wonderling DE, Mooney CZ (1997) Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 6(4):327–340CrossRefPubMed
31.
Bernard L, Mendelssohn D, Dunn E, Hutchison C, Grima D (2012) A modeled economic evaluation of sevelamer for treatment of hyperphosphatemia associated with chronic kidney disease among patients on dialysis in the United Kingdom. J Med Econ 16(1):1–9CrossRefPubMed
32.
Taylor MJ, Elgazzar HA, Chaplin S, Goldsmith D, Molony DA (2008) An economic evaluation of sevelamer in patients new to dialysis. Curr Med Res Opin 24(2):601–608CrossRefPubMed
33.
Manns B, Klarenbach S, Lee H, Culleton B, Shrive F, Tonelli M (2007) Economic evaluation of sevelamer in patients with end-stage renal disease. Nephrol Dial Transplant 22(10):2867–2878CrossRefPubMed
34.
Collins AJ, St Peter WL, Dalleska FW, Ebben JP, Ma JZ (2000) Hospitalization risks between Renagel phosphate binder treated and non-Renagel treated patients. Clin Nephrol 54(4):334–341PubMed
Metadata
Title
Sevelamer is cost effective versus calcium carbonate for the first-line treatment of hyperphosphatemia in new patients to hemodialysis: a patient-level economic evaluation of the INDEPENDENT-HD study
Authors
Matteo Ruggeri
Antonio Bellasi
Filippo Cipriani
Donald Molony
Cynthia Bell
Domenico Russo
Biagio Di Iorio
Publication date
01-10-2015
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 5/2015
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-014-0122-8

Other articles of this Issue 5/2015

Journal of Nephrology 5/2015 Go to the issue

Original Article

Tubular reabsorption of high, middle and low molecular weight proteins according to the tubulo-interstitial damage marker N-acetyl-β-d-glucosaminidase in glomerulonephritis

Original Article

Lupus nephritis in Egyptian children: a 16-year experience

Original Article

Renal diseases in adults with cystic fibrosis: a 40 year single centre experience

Original Article

Deficits in information transfer between hospital-based and primary-care physicians, the case of kidney disease: a cross-sectional study

Original Article

Efficacy of everolimus with reduced-exposure cyclosporine in de novo kidney transplant patients at increased risk for efficacy events: analysis of a randomized trial

Review

Physical methods for evaluating the nutrition status of hemodialysis patients
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits