OBJECTIVES: Hyperphosphatemia is associated with morbidity and mortality in end-stage renal disease (ESRD) patients. Phosphate binders (PBs) are the primary therapeutic treatment for hyperphosphatemia in ESRD patients receiving dialysis. Calcium-based binders are associated with an increased morbidity and mortality risk. Medicare spending on PBs has been estimated to be over $1.5 billion. The purpose of this study was to review economic evaluations of PBs to better understand their value.

METHODS: We conducted a systematic literature review of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar using the search terms “phosphate binder”, “hyperphosphatemia”, “ESRD”, “cost”, and “economic”. Results were limited to recent economic evaluations published in English in peer reviewed journals between January 2015 and December 2019. Studies included in the review reported cost-effectiveness outcomes.

RESULTS: Our search initially identified 84 publications. After removing irrelevant articles and duplicates, 5 publications met our inclusion criteria and were included in our review. Four of the five studies compared either sevelamer carbonate (SEV) or lanthanum carbonate (LC) to calcium-based binders. These analyses found SEV or LC to be cost-effective compared to calcium-based binders. A fifth study evaluated the cost effectiveness of two non-calcium-based phosphate binders, sucroferric oxyhydroxide (SO) and SEV, and found SO to be cost effective relative to SEV.

CONCLUSIONS: This review demonstrates the need for more high-quality economic evaluations of phosphate binders. The use of calcium-based binders as a comparator group is sub-optimal given the risk they may pose to patients. Only one study, which found sucroferric oxyhydroxide to be cost-effective, was found that compared non-calcium-based binders.