Reviewing cost-effectiveness evidence for phosphate binders in hyperphosphataemia in CKD

Abstract

Lanthanum carbonate, a non-calcium-based phosphate binder (NCBPB), is more cost effective than calcium-based phosphate binders (CBPBs) for the treatment of hyperphosphataemia in chronic kidney disease (CKD) in high-income countries, particularly in pre-dialysis patients. This is one of the findings of a systematic review and meta-analysis of studies that conducted economic evaluations of phosphate binders (PBs) available under current practice guidelines for the treatment of hyperphosphataemia in patients with CKD. In the meta-analysis, the incremental net benefit (INB) calculated for various PB comparisons was pooled across studies, stratified by country income. The review identified 25 studies, comprising 32 comparisons. Most of the studies (n = 20) were cost-utility analyses (CUAs), reporting cost per quality-adjusted life-year (QALY). Of the CUAs, 18 were conducted in high-income countries and 2 in upper-middle-income countries. The 9 comparisons between lanthanum carbonate versus CBPBs in high-income countries showed that lanthanum carbonate was a more cost-effective option than CBPBs, with a pooled INB of $3984.40 (year 2019 US dollars using purchasing power parity [PPP]). Subgroup analysis revealed that lanthanum carbonate was significantly more cost effective than CBPBs in pre-dialysis patients, as second-line treatment and in countries with a cost-effectiveness threshold ≥ $45 645.80, with pooled INBs of $4860.20, $4011.00 and $8218.00, respectively. The 12 comparisons between sevelamer, also a NCBPB, and CBPBs showed that sevelamer as first-line treatment was more cost effective than CBPBs in both high-income and upper-middle-income countries, without reaching statistical significance.