THE HIDDEN COST OF NON-ADHERENCE: CLINICAL AND ECONOMIC BURDEN OF SEVELAMER DISCONTINUATION IN DIALYSIS PATIENTS IN THE MEXICAN PUBLIC HEALTH SYSTEM
Author(s)
José Ángel Paladio-Hernández, MA, MS1, Yamilet Chávez-Paladio, MD2.
1Health Economics Director, PalaGod Health Supply, Mexico City, Mexico, 2PalaGod Health Supply, Mexico City, Mexico.
1Health Economics Director, PalaGod Health Supply, Mexico City, Mexico, 2PalaGod Health Supply, Mexico City, Mexico.
OBJECTIVES: Hyperphosphatemia is a major contributor to cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) undergoing dialysis. Sevelamer is a cornerstone phosphate-binding therapy; however, treatment non-adherence remains common in routine clinical practice and may lead to progressive clinical deterioration and increased healthcare expenditures. This study aimed to quantify the clinical and economic burden associated with sevelamer discontinuation over a 7-month horizon within the Mexican Institute of Social Security (IMSS).
METHODS: A deterministic monthly Markov-type model was developed from the perspective of the IMSS, comparing continuous treatment adherence versus treatment discontinuation in a hypothetical cohort of 10,000 dialysis patients. Clinical parameters—phosphate control rates, baseline cardiovascular and mortality risks, and relative risks linked to serum phosphate elevation—were informed by the IMSS clinical context and supported by published international evidence. Monthly transition probabilities were derived using exponential transformation of annualized risks, applying relative risk multipliers of 1.20 for cardiovascular events and 1.27 for mortality per mg/dL increase in serum phosphorus. Direct medical costs were obtained from official IMSS sources, including hospitalization tariffs and Diagnosis-Related Group unit costs. Costs were expressed in 2026 United States dollars (USD).
RESULTS: Non-adherence generated a progressive and cumulative clinical and economic burden. By month 7, treatment discontinuation resulted in 942 additional hospitalizations, 687 cardiovascular events, and 526 deaths per 10,000 patients compared with adherent care. Incremental costs attributable to non-adherence increased from USD 665,605 in month 1 to USD 10,142,565 by month 7, representing an approximately 15-fold escalation. Average incremental expenditure reached USD 1,014 per patient during the study horizon. Cardiovascular complications accounted for 63% of avoidable healthcare expenditures.
CONCLUSIONS: Sevelamer non-adherence may rapidly translate into avoidable morbidity, premature mortality, and substantial institutional costs within the Mexican public healthcare system, highlighting adherence-support strategies as a critical priority in CKD-mineral and bone disorder management.
METHODS: A deterministic monthly Markov-type model was developed from the perspective of the IMSS, comparing continuous treatment adherence versus treatment discontinuation in a hypothetical cohort of 10,000 dialysis patients. Clinical parameters—phosphate control rates, baseline cardiovascular and mortality risks, and relative risks linked to serum phosphate elevation—were informed by the IMSS clinical context and supported by published international evidence. Monthly transition probabilities were derived using exponential transformation of annualized risks, applying relative risk multipliers of 1.20 for cardiovascular events and 1.27 for mortality per mg/dL increase in serum phosphorus. Direct medical costs were obtained from official IMSS sources, including hospitalization tariffs and Diagnosis-Related Group unit costs. Costs were expressed in 2026 United States dollars (USD).
RESULTS: Non-adherence generated a progressive and cumulative clinical and economic burden. By month 7, treatment discontinuation resulted in 942 additional hospitalizations, 687 cardiovascular events, and 526 deaths per 10,000 patients compared with adherent care. Incremental costs attributable to non-adherence increased from USD 665,605 in month 1 to USD 10,142,565 by month 7, representing an approximately 15-fold escalation. Average incremental expenditure reached USD 1,014 per patient during the study horizon. Cardiovascular complications accounted for 63% of avoidable healthcare expenditures.
CONCLUSIONS: Sevelamer non-adherence may rapidly translate into avoidable morbidity, premature mortality, and substantial institutional costs within the Mexican public healthcare system, highlighting adherence-support strategies as a critical priority in CKD-mineral and bone disorder management.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE69
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Urinary/Kidney Disorders, STA: Multiple/Other Specialized Treatments