Cornerstone Research Group Inc., Burlington, ON, Canada.
J Med Econ. 2013;16(1):1-9. doi: 10.3111/13696998.2012.718019. Epub 2012 Sep 10.
There is limited information regarding the cost-effectiveness of sevelamer for the treatment of hyperphosphatemia in chronic kidney disease (CKD) patients on dialysis in the UK. Using a UK National Health Service (NHS) perspective and final results of the Dialysis Clinical Outcomes Revisited (DCOR) study, an evaluation was performed to determine the cost-effectiveness of sevelamer compared to calcium-based phosphate binders for the first-line treatment of hyperphosphatemia in CKD patients on dialysis.
A Markov model was developed to estimate life years, quality-adjusted life years (QALYs), costs, incremental cost per life year (LY) gained, and QALY gained. Treatment-specific overall survival up to 44 months, hospitalizations, and resource utilization were derived from the DCOR study. Survival was extrapolated to a lifetime horizon using Weibull regression analysis. Unit costs and utility estimates specific to the UK were obtained from the published literature. Sub-group analyses were conducted based on data reported from the DCOR study for increasing age cut-points. Outcomes and costs were modeled for a lifetime horizon.
In the base case analysis, the use of sevelamer resulted in a gain of ∼0.73 LYs and 0.44 QALYs per patient (discounted at 3.5% per year). Total per-patient costs were higher for sevelamer, resulting in an incremental cost of £22,157 per QALY gained and £13,427 per LY gained (in £2009). Increasingly favorable cost per QALY ratios were observed with increasing age cut-points, ranging from £15,864 for patients ≥45 to £13,296 for patients ≥65 years of age. Results were most sensitive to assumptions regarding overall survival and the inclusion of dialysis costs. Key limitations of the analysis included the use of non-UK trial data for survival and hospitalizations, and the exclusion of quality-of-life impacts associated with hospitalization.
In CKD patients receiving dialysis, treatment of hyperphosphatemia with sevelamer offers good value for money compared with calcium-based binders.
在英国，关于在接受透析治疗的慢性肾脏病（CKD）患者中使用司维拉姆治疗高磷血症的成本效益信息有限。本研究采用英国国家医疗服务体系（NHS）的观点，并结合透析临床结果再评估（DCOR）研究的最终结果，评估了与使用碳酸钙类磷结合剂相比，司维拉姆作为 CKD 透析患者高磷血症一线治疗药物的成本效益。
建立马尔可夫模型来估算生命年、质量调整生命年（QALY）、成本、每获得一个生命年（LY）的增量成本和 QALY 增益。从 DCOR 研究中获得特定于治疗的总生存数据，最长随访时间为 44 个月，以及住院和资源利用情况。使用威布尔回归分析将生存数据外推至终生。从已发表的文献中获得与英国相关的特定于亚组分析的单位成本和效用估计值。根据 DCOR 研究报告的数据，进行了基于年龄切点递增的亚组分析。对终生进行了结果和成本建模。
在基础案例分析中，使用司维拉姆可使每位患者获得约 0.73 LY 和 0.44 QALY 的增益（以 3.5%的贴现率贴现）。司维拉姆的每位患者总费用较高，增量成本为每获得 1 个 QALY 增加 £22,157，每获得 1 个 LY 增加 £13,427（按 2009 年的价格计算）。随着年龄切点的增加，成本效益比越来越有利，年龄≥45 岁的患者为 £15,864，年龄≥65 岁的患者为 £13,296。结果对总生存的假设和透析成本的纳入最为敏感。分析的主要局限性包括使用非英国试验数据进行生存和住院，以及排除与住院相关的生活质量影响。
在接受透析治疗的 CKD 患者中，与碳酸钙类结合剂相比，使用司维拉姆治疗高磷血症具有良好的性价比。
