OBJECTIVES: Hyperphosphatemia is a serious and common complication for chronic kidney disease (CKD) patients undergoing dialysis. There is a need for an effective phosphate-lowering therapy. Sucroferric oxyhydroxide (SFOH) has been shown to effectively lower serum phosphate levels in dialysis patients. This study aimed to assess the costs and health consequences of SFOH in the management of hyperphosphatemia for CKD patients undergoing dialysis in Canada.

METHODS: Using a Markov health-state transition model, and the perspective of a publicly funded health care system, we compared the cost-effectiveness of SFOH with sevelamer (SEV) over a 10-year time horizon. The model included multiple health states i.e., on target, off target, alternative treatment on target, alternative treatment off target, renal transplant and death. Off-target patients could switch therapy receiving either SEV or lanthanum carbonate, for SFOH and SEV, respectively. Efficacy data was extrapolated from a pivotal Phase III clinical trial assessing SFOH versus SEV. Costs and utilities were adapted to the Canadian context, using provincial databases and published literature, and were annually discounted at 1.5%. Probabilistic analysis and scenario sensitivity analyses were performed to examine the impact of uncertainty in input parameters.

RESULTS: In the base-case deterministic scenario, SFOH resulted in higher per patient incremental costs of C$1,222 and an incremental effect of 0.03 QALYs gained. Higher treatment costs for SFOH are due to a slight mortality benefit for SFOH and higher consumption of costs as a result of increased survival. The incremental cost-utility ratio was estimated at C$37,553 per QALY gained. Probabilistic analysis showed with >60% likelihood that SFOH results in efficient use of healthcare resources in Canada.

CONCLUSIONS: SFOH appears to be a cost effective treatment in Canada for CKD patients on dialysis with hyperphosphatemia.