University of Groningen Cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in chronic kidney disease before and during dialysis Vegter,

t e g a s C s t Q p K n b C Objectives: Hyperphosphatemia is a common and harmful condition in patients with chronic kidney disease (CKD). We determined the costeffectiveness of the noncalcium-based phosphate binder lanthanum carbonate (LC) as second-line treatment of hyperphosphatemia after therapy failure with calcium-based binders (CB). Methods: Two CKD populations were modeled: 1) predialysis CKD patients and 2) incident dialysis patients. Patients not responding to CB with a serum phosphate (SP) level 5.5 mg/dl received a trial with LC. Patients not responding to LC (SP 4.6 mg/dl) returned to CB treatment. Patient-level data were obtained from clinical trials in predialysis and dialysis. Timedependent, life-long Markov models (discounting at 3.5% annually) were developed, using a UK National Health Service perspective. Results: The health gains with second-line LC treatment compared to CB treatment were 44 and 56 quality-adjusted life-years (QALYs) for the predialysis and incident dialysis populations, respectively. Second-line LC was a cost-saving strategy in the predialysis population because of O