The influence of future unrelated costs on costeffectiveness estimates: Treatment of hyperphosphatemia with lanthanum carbonate in pre-dialyis patients with chronic kidney disease

S. Vegter, K. Tolley, M. Keith, M.J. Postma

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    OBJECTIVES: A long-standing controversy in health-economics is whether future unrelated costs should be included in cost-effectiveness analyses. This discussion is relevant in Chronic Kidney Disease (CKD) for treatments that delay progression towards dialysis and prolong survival. In this study, we determined the influence of future unrelated costs on the cost-effectiveness of the non-calcium based phosphate binder lanthanum carbonate (LC) when used as second-line treatment for hyperphosphatemia in predialysis patients. METHODS: Time-dependent Markov models were constructed; cohorts of 1000 patients were followed lifelong. Patients not reaching target serum phosphate (SP) levels on first-line calcium based phosphate binders (CB) were treated with LC. This strategy was compared with continued CB treatment. Patient-level data were pooled from two clinical trials, one in predialysis and one in dialysis. Reductions in SP levels delayed progression towards dialysis and prolonged survival. RESULTS: For the predialysis cohort, 544 did not achieve target SP levels (
    Original languageEnglish
    Pages (from-to)478
    Number of pages1
    JournalValue in Health
    Volume13
    Issue number7
    Publication statusPublished - 1-Nov-2010

    Keywords

    • lanthanum carbonate
    • calcium
    • phosphate binding agent
    • chronic kidney disease
    • patient
    • human
    • hyperphosphatemia
    • dialysis
    • cost effectiveness analysis
    • survival
    • health economics
    • model
    • phosphate blood level
    • clinical trial (topic)
    • health care cost
    • cost control
    • reimbursement
    • sensitivity analysis

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