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Value Health. 2009 Jan-Feb;12(1):16-9. doi: 10.1111/j.1524-4733.2008.00408.x. Epub 2008 Jul 18.

Prevention and management of hyperphosphatemia with sevelamer in Canada: health and economic consequences.

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  • 1Caro Research Institute, Concord, MA 01742, USA. krista.huybrechts@unitedbiosource.com

Abstract

BACKGROUND:

Sevelamer hydrochloride (Renagel) binds phosphate in patients with end-stage renal disease without the use of exogenous calcium and may reduce the progression of coronary vascular calcification. This intervention was shown to be cost-effective in the United States. This paper presents the Canadian adaptation.

METHODS:

A discrete event simulation of the long-term cardiovascular implications of 1 year of phosphate binding in a prevalent hemodialysis population was used to estimate the cost-effectiveness of sevelamer use in Canada based on the demographics, comorbidities, physiological and renal characteristics. Initial calcification score and expected changes over 1 year were derived using regression equations developed from a clinical trial and translated to cardiovascular disease risk based on equations developed from a long-term cohort study. Direct medical costs from a Canadian Medicare perspective were taken from Ontario data. Ten replications of 10,000 patients over 13 years (discounting at 3%) were done for the base case and extensive sensitivity analyses were conducted.

RESULTS:

The cardioprotective effect of sevelamer over 1 year is estimated to prevent 10 cardiovascular events and gain 18 life-years compared with calcium carbonate in 100 patients over a lifetime. These benefits are obtained at a net cost of CAD$2,096; an incremental cost-effectiveness ratio of CAD$12,384 per discounted life-year gained. Sensitivity analyses showed that the time horizon and efficacy were the most important factors.

CONCLUSION:

The results of this study provide evidence that use of sevelamer in Canada would be economically sound.

PMID:
18647261
[PubMed - indexed for MEDLINE]
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