University of Texas at Austin College of Pharmacy, Austin, TX, USA.
Value Health. 2011 Dec;14(8):1002-9. doi: 10.1016/j.jval.2011.05.043. Epub 2011 Jul 28.
To assess the cost-effectiveness of lanthanum carbonate (LC) versus sevelamer hydrochloride (SH) as a treatment for hyperphosphatemia in end-stage renal disease (ESRD) patients.
A Markov model was developed to estimate health outcomes; quality-adjusted life years (QALYs) and life-years saved (LYS), as well as associated costs. The model incorporated patient-level data from a randomized head-to-head crossover study that compared the reduction of serum phosphorus using LC and SH for 4 weeks each. The model included patients previously treated with calcium-based binders. Both the intent-to-treat (ITT) population and the cohort of patients who completed treatment in both periods of the study (i.e., completer population) were assessed. The baseline risks of cardiovascular disease (CVD), all-cause mortalities for CVD, and non-CVD patients were derived from a large US renal database. Patient outcomes were modeled for 10 years, and incremental cost-effectiveness ratios (ICERs) were calculated for LC relative to SH. Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the base-case model.
For the ITT population, the ICERs of LC versus SH were $24,724/QALY and $15,053/LYS, respectively (in US dollars). When the completer population was considered, the ICERs of LC versus SH were $15,285/QALY and $9,337/LYS (Table 2), respectively. The PSA indicated 61.9% and 85.8% probabilities for ITT and completer populations of LC being cost-effective at the $50,000/QALY willingness-to-pay threshold, respectively.
LC is a cost-effective strategy compared with SH in the treatment of ESRD patients with hyperphosphatemia who were previously treated with calcium-based binders. Sensitivity analyses demonstrated the robustness of the pharmacoeconomic model.
评估碳酸镧（LC）与盐酸司维拉姆（SH）治疗终末期肾病（ESRD）患者高磷血症的成本效果。
采用 Markov 模型评估健康结果，包括质量调整生命年（QALY）和生命年节省（LYS）以及相关成本。该模型纳入了一项随机头对头交叉研究的患者个体数据，该研究比较了 LC 和 SH 分别治疗 4 周对血清磷的降低作用。该模型纳入了先前使用过钙基结合剂治疗的患者。评估了意向治疗（ITT）人群和完成研究两个治疗期（即完成治疗人群）的患者队列。心血管疾病（CVD）的基线风险、CVD 和非 CVD 患者的全因死亡率来自于一个大型美国肾脏数据库。对患者的 10 年结局进行建模，并计算 LC 相对于 SH 的增量成本效果比（ICER）。进行了确定性和概率敏感性分析（PSA）以检验基础模型的稳健性。
对于 ITT 人群，LC 相对于 SH 的 ICER 分别为 24724 美元/QALY 和 15053 美元/LYS。当考虑完成治疗人群时，LC 相对于 SH 的 ICER 分别为 15285 美元/QALY 和 9337 美元/LYS（表 2）。PSA 表明在 50000 美元/QALY 的支付意愿阈值下，ITT 人群和完成治疗人群中分别有 61.9%和 85.8%的可能性认为 LC 具有成本效果。
对于先前使用钙基结合剂治疗的 ESRD 高磷血症患者，LC 是一种与 SH 相比具有成本效果的治疗策略。敏感性分析表明药物经济学模型具有稳健性。
