The Economic Impact of Improving Phosphate Binder Therapy Adherence and Attainment of Guideline Phosphorus Goals in Hemodialysis Patients: a Medicare Cost-Offset Model

• Published in: Advances in therapy 2014-12, Vol.31 (12), p.1272-1286
• Main Authors: Ramakrishnan, Karthik, Braunhofer, Peter, Newsome, Britt, Lubeck, Deborah, Wang, Steven, Deuson, Jennifer, Claxton, Ami J.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology; Chelating Agents - therapeutic use; Cost Savings; Emergency and intensive care: renal failure. Dialysis management; Endocrinology; Female; Health Care Costs; Health technology assessment; Humans; Hyperphosphatemia - blood; Hyperphosphatemia - drug therapy; Hyperphosphatemia - economics; Hyperphosphatemia - etiology; Intensive care medicine; Internal Medicine; Kidney Failure, Chronic - therapy; Male; Medical sciences; Medicare - economics; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Oncology; Original Research; Pharmacology. Drug treatments; Pharmacology/Toxicology; Phosphates - blood; Phosphorus - blood; Practice Guidelines as Topic; Renal Dialysis - adverse effects; Renal Dialysis - economics; Retrospective Studies; Rheumatology; United States
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-014-0170-4

Introduction Hyperphosphatemia (serum phosphorus >5.5 mg/dL) in hemodialysis patients is a key factor in mineral and bone disorders and is associated with increased hospitalization and mortality risks. Treatment with oral phosphate binders offers limited benefit in achieving target serum phosphorus concentrations due to high daily pill burden (7–10 pills/day) and associated poor medication adherence. The economic value of improving phosphate binder adherence and increasing percent time in range (PTR) for target phosphorus concentrations has not been previously assessed in dialysis patients. The current retrospective analysis was conducted to summarize health care cost savings to United States (US) payers associated with improved phosphate binder adherence and increased PTR for target phosphorus concentrations in adult end-stage renal disease (ESRD) patients receiving hemodialysis therapy. Methods Phosphate binder adherence and PTR were derived from hemodialysis patients who were treated at a large dialysis organization between January 2007 and December 2011. Cost model inputs were derived from US Renal Data System data between July 2007 and December 2009. A cost-offset model was constructed to estimate monthly and annual incremental health care costs (total Medicare; inpatient, outpatient, and Medicare Part B) associated with different levels of phosphate binder adherence and PTR. Model inputs included number of ESRD patients, population adherence to phosphate binders, PTR associated with adherence to phosphate binders, and per-patient per-month cost associated with PTR. A base case model estimated monthly and annual costs of phosphate binder therapy in the population using estimated model inputs. The estimated adherence rate was used to determine number of patients in compliant and noncompliant groups. Monthly costs were calculated as the sum of per-patient per-month cost times the number of patients in adherent and nonadherent groups. Annual costs were monthly costs times 12 and assumed the same level of adherence, PTR, and per-patient per-month costs over time. To study the impact of improving phosphate binder adherence and PTR on cost outcomes, we hypothetically and simultaneously increased both base phosphate binders adherence and PTR for adherent patients (adherence/PTR: 10/20%, 20/40%, 30/60%). Monthly and annual costs were derived for each scenario and compared against the results of the base case model. One-way sensitivity analysis was performed t