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Kidney Week

Abstract: PO0372

Determining the Value of Pharmaceutical Treatment of Hyperphosphatemia with Phosphate Binders: A Systematic Review

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Rosen, Melissa M., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States

Phosphate binders (PBs) are the primary therapeutic treatment for hyperphosphatemia in ESRD patients receiving dialysis. Medicare spending on PBs has been estimated to be over $1.5 billion. There is increased focus on value-based prescribing as a method to control rising healthcare spending in the U.S. However, guidance to support such decisions is limited. The purpose of this study was to review economic evaluations of PBs to understand if specific binders are associated with greater value to patients and payers.


We conducted a systematic literature review with results restricted to economic evaluations published in English in peer reviewed journals between January 2015 and May 2020. Studies included in the review reported cost-effectiveness outcomes.


After removing irrelevant articles and duplicates, 8 publications were found that met our inclusion criteria. Four (50%) studies compared either sevelamer carbonate (SEV) or lanthanum carbonate (LC) to calcium-based binders. SEV or LC was cost-effective compared to calcium-based binders. Two studies focused on ferric citrate (FC) with one comparing FC to the standard of care (either calcium acetate, SEV, or LC), and the other to SEV or calcium acetate. The results favored FC based on differences in the use of erythropoiesis-stimulating agents and hospitalization risk. However, these studies did not examine the potential for unsafe levels of iron absorption associated with FC use. The remaining two studies evaluated sucroferric oxyhydroxide (SO). One study found SO to be cost-effective relative to SEV based on clinical trial data. The other analysis looked at patients prescribed SO for two years compared to those who discontinued use after 90 days and switched to another binder. This model estimated that SO use had the potential to be cost-saving based on reduced risk of hospitalization. We were unable to find an economic evaluation that compared the two iron-based binders, SO to FC.


This review demonstrates the need for more economic evaluations of phosphate binders. Only one cost-effectiveness analysis was found that compared two non-calcium binders (SO vs SEV) head-to-head. In addition to cost analyses, payers may benefit from reviewing real-world data to examine the clinical benefits of specific phosphate binders.


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