TY - JOUR
T1 - Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in japan
AU - Goto, Shunsuke
AU - Komaba, Hirotaka
AU - Moriwaki, Kensuke
AU - Fujimori, Akira
AU - Shibuya, Koji
AU - Nishioka, Masato
AU - Kim, Jong Il
AU - Yoshiya, Kunihiko
AU - Shin, Jeongsoo
AU - Hasegawa, Hirohito
AU - Taniguchi, Masatomo
AU - Fujii, Hideki
AU - Nishi, Shinichi
AU - Kamae, Isao
AU - Fukagawa, Masafumi
PY - 2011/6/1
Y1 - 2011/6/1
N2 - Background and objectives Lanthanum carbonate (LC) is a nonaluminum, noncalcium phosphate binder that is effective for hyperphosphatemia in dialysis patients. However, its efficacy and cost-effectiveness as second-line therapy have not been fully examined. Design, setting, participants, & measurements We first conducted a multicenter, open-label, 16-week clinical trial to examine the effect of additive LC in 116 hemodialysis patients who had uncontrolled hyperphosphatemia with conventional phosphorus-lowering therapy alone. Based on these clinical data, a state transition model was developed to evaluate the benefits and costs associated with LC as second-line therapy. Reduced risks for cardiovascular morbidity and mortality among patients treated with LC arise through more of the population achieving the target phosphorus levels. Uncertainty was explored through sensitivity analysis. Results After 16 weeks of additive LC treatment, mean serum phosphorus levels decreased from 7.30 _ 0.90 to 5.71 ± 1.32 mg/dl, without significant changes in serum calcium or intact parathyroid hormone levels. A subsequent cost-effectiveness analysis showed that compared with conventional treatment, additive LC incurred an average additional lifetime cost of $22,054 per person and conferred an additional 0.632 quality adjusted life years (QALYs). This resulted in an incremental cost-effectiveness ratio of $34,896 per QALY gained. Applying a cost-effectiveness threshold of $50,000 per QALY, a probabilistic sensitivity analysis showed that additive LC had a 97.4% probability of being cost-effective compared with conventional treatment. Conclusions Our results indicate that the use of LC as second-line therapy would be cost-effective among hemodialysis patients with uncontrolled hyperphosphatemia in Japan.
AB - Background and objectives Lanthanum carbonate (LC) is a nonaluminum, noncalcium phosphate binder that is effective for hyperphosphatemia in dialysis patients. However, its efficacy and cost-effectiveness as second-line therapy have not been fully examined. Design, setting, participants, & measurements We first conducted a multicenter, open-label, 16-week clinical trial to examine the effect of additive LC in 116 hemodialysis patients who had uncontrolled hyperphosphatemia with conventional phosphorus-lowering therapy alone. Based on these clinical data, a state transition model was developed to evaluate the benefits and costs associated with LC as second-line therapy. Reduced risks for cardiovascular morbidity and mortality among patients treated with LC arise through more of the population achieving the target phosphorus levels. Uncertainty was explored through sensitivity analysis. Results After 16 weeks of additive LC treatment, mean serum phosphorus levels decreased from 7.30 _ 0.90 to 5.71 ± 1.32 mg/dl, without significant changes in serum calcium or intact parathyroid hormone levels. A subsequent cost-effectiveness analysis showed that compared with conventional treatment, additive LC incurred an average additional lifetime cost of $22,054 per person and conferred an additional 0.632 quality adjusted life years (QALYs). This resulted in an incremental cost-effectiveness ratio of $34,896 per QALY gained. Applying a cost-effectiveness threshold of $50,000 per QALY, a probabilistic sensitivity analysis showed that additive LC had a 97.4% probability of being cost-effective compared with conventional treatment. Conclusions Our results indicate that the use of LC as second-line therapy would be cost-effective among hemodialysis patients with uncontrolled hyperphosphatemia in Japan.
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U2 - 10.2215/CJN.08841010
DO - 10.2215/CJN.08841010
M3 - Article
C2 - 21551021
AN - SCOPUS:79958201887
SN - 1555-9041
VL - 6
SP - 1375
EP - 1384
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -