OBJECTIVES: Comparative data is routinely preferred by reimbursement decision makers.  The study objective was to estimate the dose relativity of two non-calcium based phosphate binders, lanthanum carbonate (LC) and sevelamer hydrochloride (SH) in the treatment of end-stage renal disease (ESRD).  METHODS: An indirect comparison based on a systematic literature review and Bayesian mixed treatment meta-analysis methodology was used to determine the equipotent doses of LC and SH.  The methodology met Australian Pharmaceutical Benefits Advisory Committee standards, a rigorous Health Technology Assessment Agency.  The outcome measure of interest in ERSD was the mean daily dose required to control serum phosphate at target levels.  The data were analyzed using WinBUGS software.  Posterior results were estimated using 25,000 samples after a burn-in of 25,000 iterations and thinning the MCMC chain every 25 iterations to account for autocorrelation.  Goodness-of-fit was also assessed. RESULTS: The literature review identified nine trials and three treatments comparing LC to calcium (6), SH to calcium (2) and SH to LC (1).  An unconstrained baseline model using a gamma likelihood for the sample mean doses (and sample variances) required to achieve a specific phosphate reduction and control was fitted.  An a priori assumption was that the population standard deviations between treatments were different.  The analysis showed that the dose required to achieve phosphate reduction and control was 2.33 (95% Crl: 1.75, 3.01) times greater with SH versus LC.  The dose relatively is consistent with the ratio calculated using the World Health Organization's defined daily dose for LC and SH. CONCLUSIONS: This study illustrates how a mixed-treatment comparison can be used to aid in drug therapy decision making when direct head-to-head data is limited.  Using this approach, the dose relativity ratio of the mean daily dose of sevelamer to the mean daily dose of lanthanum carbonate was determined as 2.33.