MP591COST-MINIMISATION ANALYSIS OF SUCROFERRIC OXYHYDROXIDE AND SEVELAMER CARBONATE IN PATIENTS ON DIALYSIS WITH SECONDARY HYPERPARATHYROIDISM IN THE UNITED KINGDOM

Abstract

Introduction and Aims: Many patients with chronic kidney disease (CKD) on dialysis require vitamin D therapy for managing secondary hyperparathyroidism (SHPT). In a post hoc analysis of a Phase 3 study, it has been shown that the oral phosphate binder sucroferric oxyhydroxide (SFOH) had no apparent interaction with oral vitamin D therapies. The reduction in serum intact parathyroid hormone (iPTH) as a marker of response to exogenous vitamin D was similar in patients receiving oral or IV vitamin D therapies. In contrast, a potential interaction between sevelamer carbonate (SEV) and oral vitamin D therapies has been shown, which was not the case with intravenous (IV) vitamin D administration. These findings are consistent with a pharmacokinetic study, which demonstrated that SEV reduced the bioavailability of oral calcitriol when administered together. The present cost-minimisation analysis determined the economic impact of using SFOH vs SEV for dialysis patients receiving concomitant vitamin D agents, from the United Kingdom (UK) National Health Service perspective. Methods: Information on drug dosage was derived from two Phase 3 clinical trials (NCT01324128 and NCT01464190). Treatment costs for patients with serum phosphate concentrations ≥6.0 mg/dL receiving either SFOH (1.5 g/day [3 tablets/ day]) or SEV (6.4 g/day [8 tablets/day]) were assessed. Based on clinical results described above, it was assumed that patients on SFOH are treated exclusively with oral vitamin D (calcitriol, 0.28 μg/day), whereas patients on SEV are treated with IV vitamin D agents (paricalcitol, 1.84 μg/day). Costs for the administration of paricalcitol and costs for treatment of adverse events were not included. Drug acquisition costs were determined on the basis of the UK wholesaler price (British National Formulary). Uncertainties in the model parameters were addressed using one-way sensitivity analyses. Results: Treatment with SFOH and SEV resulted in annual per patient costs of GBP 2,178 and GBP 2,578, respectively. Annual vitamin D therapy with oral calcitriol resulted in per patient cost of GBP 122 compared with GBP 930 for IV paricalcitol. SFOH treatment with calcitriol (total costs: GBP 2,300) versus SEV with paricalcitol (total costs: GBP 3,508) resulted in an annual cost-saving of GBP 1,207 per patient. Variation of drug prices by ±25% in the one-way sensitivity analyses did not change the conclusion of the base-case. Conclusions: This study provides evidence that concomitant use of SFOH and oral calcitriol may have an economic benefit, in comparison with using SEV and IV paricalcitol concomitantly, when treating UK CKD patients with SHPT. Economic savings might be substantial for the UK healthcare system, but real-world data are needed to confirm these findings.