Background

Uncontrolled hyperphosphatemia in chronic kidney disease (CKD) patients commonly results in vascular calcification leading to increased risk of cardiovascular disease. Phosphate binders (PBs) are used for hyperphosphatemia and can be calcium-based (CBPBs) or non-calcium-based (NCBPBs), the latter being more expensive than CBPBs. In this study, we used meta-analysis approaches to assess the cost-utility of PBs for hyperphosphatemia in CKD patients.

Methods

Relevant studies published prior to June 2019 were identified from PubMed, Scopus, the Cochrane Library, the National Health Service Economic Evaluation Database, and the Cost-Effectiveness Analysis Registry. Studies were eligible if they included CKD patients with hyperphosphatemia, compared any PBs and reported economic outcomes. Meta-analysis was applied to pool incremental net benefit (INB) across studies stratified by country income.

Results

A total of 25 studies encompassing 32 comparisons were eligible. Lanthanum carbonate, a NCBPB, was a more cost-effective option than CBPBs in high-income countries (HICs), with a pooled INB of $3984.4 (599.5–7369.4), especially in pre-dialysis patients and used as a second-line option with INBs of $4860.2 (641.5–9078.8), $4011.0 (533.7–7488.3), respectively. Sevelamer, also a NCBPB, was not more cost-effective as a first-line option compared to CBPBs with a pooled INB of $6045.8 (− 23,453.0 to 35,522.6) and $34,168.9 (− 638.0 to 68,975.7) in HICs and upper middle-income countries, respectively.

Conclusions

Lanthanum carbonate was significantly more cost-effective than CBPBs as a second-line option for hyperphosphatemia in pre-dialysis patients in HICs. However, the use of sevelamer is not more cost-effective as a first-line option compared to CBPBs.

中文翻译：

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磷酸盐结合剂作为慢性肾病患者高磷血症治疗选择的成本效用评估：经济评估的系统回顾和荟萃分析

 背景

慢性肾病（CKD）患者不受控制的高磷血症通常会导致血管钙化，从而增加心血管疾病的风险。磷酸盐结合剂 (PB) 用于治疗高磷血症，可以是钙基 (CBPB) 或非钙基 (NCBPB)，后者比 CBPB 更昂贵。在这项研究中，我们使用荟萃分析方法来评估 PB 治疗 CKD 患者高磷血症的成本效用。

 方法

2019 年 6 月之前发表的相关研究来自 PubMed、Scopus、Cochrane 图书馆、国家卫生服务经济评估数据库和成本效益分析登记处。如果研究纳入患有高磷血症的 CKD 患者，比较任何 PB 并报告经济结果，则研究是合格的。采用荟萃分析来汇总按国家收入分层的研究中的增量净收益 (INB)。

 结果

共有 25 项研究（包含 32 项比较）符合资格。碳酸镧是一种 NCBPB，在高收入国家 (HIC) 中是比 CBPB 更具成本效益的选择，综合 INB 为 3984.4 美元 (599.5–7369.4)，特别是在透析前患者中，并用作二线选择INB 分别为 4860.2 美元 (641.5–9078.8)、4011.0 美元 (533.7–7488.3)。与 CBPB 相比，司维拉姆也是一种 NCBPB，作为一线选择并没有更具成本效益，高收入国家和中高收入国家的综合 INB 为 6045.8 美元（− 23,453.0 至 35,522.6）和 34,168.9 美元（− 638.0 至 68,975.7），分别。

 结论

作为 HIC 透析前患者高磷血症的二线选择，碳酸镧比 CBPB 更具成本效益。然而，与 CBPB 相比，使用司维拉姆作为一线选择并不更具成本效益。