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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

Author

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  • Kamolpat Chaiyakittisopon

    (Ramathibodi Hospital, Mahidol University
    Silpakorn University)

  • Oraluck Pattanaprateep

    (Ramathibodi Hospital, Mahidol University)

  • Narisa Ruenroengbun

    (Ramathibodi Hospital, Mahidol University
    Silpakorn University)

  • Tunlanut Sapankaew

    (Ramathibodi Hospital, Mahidol University)

  • Atiporn Ingsathit

    (Ramathibodi Hospital, Mahidol University)

  • Gareth J. Mckay

    (Queen’s University Belfast)

  • John Attia

    (Hunter Medical Research Institute, University of Newcastle)

  • Ammarin Thakkinstian

    (Ramathibodi Hospital, Mahidol University)

Abstract

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.

Suggested Citation

  • Kamolpat Chaiyakittisopon & Oraluck Pattanaprateep & Narisa Ruenroengbun & Tunlanut Sapankaew & Atiporn Ingsathit & Gareth J. Mckay & John Attia & Ammarin Thakkinstian, 2021. "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," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(4), pages 571-584, June.
  • Handle: RePEc:spr:eujhec:v:22:y:2021:i:4:d:10.1007_s10198-021-01275-3
    DOI: 10.1007/s10198-021-01275-3
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    References listed on IDEAS

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    More about this item

    Keywords

    Economic evaluation; Hyperphosphatemia; Incremental net benefit; Meta-analysis; Phosphate binders;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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