Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in japan

Shunsuke Goto, Hirotaka Komaba, Kensuke Moriwaki, Akira Fujimori, Koji Shibuya, Masato Nishioka, Jong Il Kim, Kunihiko Yoshiya, Jeongsoo Shin, Hirohito Hasegawa, Masatomo Taniguchi, Hideki Fujii, Shinichi Nishi, Isao Kamae, Masafumi Fukagawa

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1375-1384
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2011

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Cost-Benefit Analysis
Renal Dialysis
Japan
Hyperphosphatemia
Quality-Adjusted Life Years
Phosphorus
Therapeutics
Costs and Cost Analysis
lanthanum carbonate
Health Services Needs and Demand
Parathyroid Hormone
Serum
Uncertainty
Dialysis
Phosphates
Clinical Trials
Calcium
Morbidity
Mortality

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in japan. / Goto, Shunsuke; Komaba, Hirotaka; Moriwaki, Kensuke; Fujimori, Akira; Shibuya, Koji; Nishioka, Masato; Kim, Jong Il; Yoshiya, Kunihiko; Shin, Jeongsoo; Hasegawa, Hirohito; Taniguchi, Masatomo; Fujii, Hideki; Nishi, Shinichi; Kamae, Isao; Fukagawa, Masafumi.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 6, 01.06.2011, p. 1375-1384.

Research output: Contribution to journalArticle

Goto, S, Komaba, H, Moriwaki, K, Fujimori, A, Shibuya, K, Nishioka, M, Kim, JI, Yoshiya, K, Shin, J, Hasegawa, H, Taniguchi, M, Fujii, H, Nishi, S, Kamae, I & Fukagawa, M 2011, 'Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in japan', Clinical Journal of the American Society of Nephrology, vol. 6, no. 6, pp. 1375-1384. https://doi.org/10.2215/CJN.08841010
Goto, Shunsuke ; Komaba, Hirotaka ; Moriwaki, Kensuke ; Fujimori, Akira ; Shibuya, Koji ; Nishioka, Masato ; Kim, Jong Il ; Yoshiya, Kunihiko ; Shin, Jeongsoo ; Hasegawa, Hirohito ; Taniguchi, Masatomo ; Fujii, Hideki ; Nishi, Shinichi ; Kamae, Isao ; Fukagawa, Masafumi. / Clinical efficacy and cost-effectiveness of lanthanum carbonate as second-line therapy in hemodialysis patients in japan. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 6. pp. 1375-1384.
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abstract = "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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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

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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.

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