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Sevelamer Carbonate and Lanthanum Usage Evaluation and Cost Considerations at a Veterans Affairs Medical Center

机译：Sevelamer碳酸盐和镧的使用评估和退伍军人事务医疗中心的成本考虑

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>Background: Hyperphosphatemia is a common problem in patients with chronic kidney disease (CKD). Calcium-containing phosphate binders are typically used as first-line therapy, primarily due to cost considerations. Non-calcium phosphate binders such as sevelamer and lanthanum may be considered in the appropriate setting. It is hypothesized that lanthanum is less costly and has a lower pill burden compared to sevelamer carbonate.>Objective: Determine the difference in cost (outcome 1) and tablet burden (outcome 2) between sevelamer carbonate and lanthanum within the Veteran population.>Methods: Patients with an active prescription for lanthanum or sevelamer carbonate on October 22, 2014 were evaluated. Chi-square analysis was used to analyze categorical data, and 2-sided t test was used for continuous data. An α of 0.05 determined significance.>Results: One hundred fifty patients were included in the evaluation. Patients were predominately male (96%) and had a diagnosis of end stage renal disease (ESRD; 78%). The combined rate of non-dialysis CKD (ND-CKD) stage 5 and ESRD was similar between lanthanum and sevelamer carbonate groups. Both groups achieved similar phosphorus control (56% vs 65%, with phosphorus level less than or equal to 5.5 mg/dL, respectively; P = .23). Lanthanum prescriptions required significantly fewer tablets per day (4 lanthanum tablets daily vs 7 sevelamer carbonate tablets daily; P < .001). A potential prescription cost savings of approximately $4,500 monthly or $54,000 annually was seen when considering conversion of patients in this study population from sevelamer carbonate to lanthanum therapy, with appreciable savings beginning at sevelamer daily doses of at least 4,800 mg.>Conclusions: Compared to sevelamer carbonate, lanthanum use was associated with reduced pill burden and lower absolute drug cost while maintaining similar phosphorus control.
机译：>背景：高磷血症是慢性肾脏病（CKD）患者的常见问题。主要出于成本考虑，通常将含钙的磷酸盐粘合剂用作一线治疗药物。在适当的环境下可以考虑使用非磷酸钙粘合剂，例如司维拉姆和镧。假设与碳酸司维拉姆相比，镧的成本较低，并且丸剂负担较低。>目的：确定碳酸司维拉姆和镧之间的成本（结果1）和片剂负担（结果2）之间的差异>方法：对2014年10月22日有有效处方镧或司维拉姆的人进行了评估。卡方分析用于分类数据分析，两面t检验用于连续数据分析。确定的显着性α为0.05。>结果：评估了150例患者。患者主要为男性（96％），并诊断为终末期肾脏疾病（ESRD； 78％）。镧和碳酸司维拉姆组的非透析CKD（ND-CKD）第5阶段和ESRD的合并率相似。两组均实现了相似的磷控制（分别为56％和65％，磷含量分别小于或等于5.5 mg / dL； P = 0.23）。镧处方每天所需的片剂明显减少（每天4片镧片剂与每天7片司维拉姆碳酸片剂； P <.001）。当考虑将这个研究人群中的患者从碳酸司维拉姆转换为镧治疗时，每月可节省约4,500美元或每年54,000美元的处方费用，从司维拉姆每日剂量至少4,800 mg开始可观的节省。>结论：< / strong>与司维拉姆碳酸盐相比，镧的使用可减少药丸负担并降低绝对药物成本，同时保持类似的磷控制。

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