Objectives: In a 36-month, open label RCT that involved 213 patients in stage 3-4 nondialysis-dependent CKD (NDD-CKD) (INDEPENDENT study), sevelamer showed lower rates of all-cause mortality and dialysis inception vs. calcium carbonate. The aim of this study was to assess the cost-effectiveness of sevelamer vs. calcium carbonate in NDD-CKD patients with hyperphosphatemia in Spain. Methods: A Spanish National Health System perspective and lifetime horizon was chosen for the analysis. A Markov model was developed considering health states of "alive with NDD-CKD", "alive with dialysis-dependent CKD", and "dead"). All-cause mortality, dialysis inception, hospitalization (frequency and length of stay [LOS]), and drug dosage data were taken from the INDEPENDENT study. All-cause mortality and dialysis inception were extrapolated beyond 36 months using Weibull regression analysis. Local costs (euros, 2014) were applied to pharmaceutical, hospitalization and dialysis utilization. Health utility data was taken from the published literature. Costs and effects were discounted at a rate of 3%. Results: In the base case analysis sevelamer was associated with increased survival, delay in dialysis inception, fewer hospitalizations, shorter LOS, 2,12 life years gained (LYG) and 1,61 quality-adjusted life years gained (QALYG) vs. calcium carbonate. Increased survival translated into more treatment time and dialysis sessions vs. calcium carbonate, resulting in an incremental cost of 33.687 . The incremental cost per LYG for sevelamer vs. calcium carbonate was 15.897 and the incremental costs per QALY gained was 20.883 . Sensitivity analysis showed that sevelamer was more effective and less costly (i.e., dominant) vs. calcium carbonate in time horizons < 6 years. Conclusions: The Spanish analysis showed that sevelamer is a cost-effective strategy vs. calcium carbonate for the treatment of hyperphosphatemia in patients with NDD-CKD, with cost-effectiveness ratios well below the accepted thresholds of 30.000-45.000 /QALY gained.
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