Matteo Ruggeri1, Antonio Bellasi2,3, Filippo Cipriani4, Donald Molony5, Cynthia Bell6, Domenico Russo7, Biagio Di Iorio8. 1. Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy. 2. Division of Nephrology, Sant'Anna Hospital, Como, Italy. 3. Department of Health Sciences, University of Milan, Milan, Italy. 4. Market Access and Corporate Affairs, Genzyme, Italy. 5. Division of Renal Dis and Hypertension, Department of Medicine, University of Texas Houston Medical School, Houston, TX, USA. 6. Division of Pediatric Nephrology, Department of Pediatrics, University of Texas Houston Medical School, Houston, TX, USA. 7. Department of Nephrology, School of Medicine, Federico II University, Naples, Italy. 8. Department of Nephrology, Ospedale A. Landolfi di Solofra, Solofra (AV), Italy. br.diiorio@gmail.com.
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.
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.
Authors: José Luis Fernández-Martín; Juan Jesus Carrero; Miha Benedik; Willem-Jan Bos; Adrian Covic; Aníbal Ferreira; Jürgen Floege; David Goldsmith; José Luis Gorriz; Markus Ketteler; Reinhard Kramar; Francesco Locatelli; Gérard London; Pierre-Yves Martin; Dimitrios Memmos; Judit Nagy; Manuel Naves-Díaz; Drasko Pavlovic; Minerva Rodríguez-García; Boleslaw Rutkowski; Vladimir Teplan; Christian Tielemans; Dierik Verbeelen; Rudolf P Wüthrich; Pablo Martínez-Camblor; Iván Cabezas-Rodriguez; José Emilio Sánchez-Alvarez; Jorge B Cannata-Andia Journal: Nephrol Dial Transplant Date: 2012-11-19 Impact factor: 5.992
Authors: Björn Stollenwerk; Sergio Iannazzo; Ron Akehurst; Michael Adena; Andrew Briggs; Bastian Dehmel; Patrick Parfrey; Vasily Belozeroff Journal: Pharmacoeconomics Date: 2018-05 Impact factor: 4.981