Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review

Managing hyperphosphataemia in haemodialysis patients is resource‐intensive. A search for cost‐effective interventions in this field is needed to inform decisions on the allocation of healthcare resources. NHSEED , MEDLINE , EMBASE and CINAHL were searched for full economic evaluations of hyperphosphataemia‐managing interventions in adult haemodialysis patients, published between 2004 and 2014, in E nglish, F rench, D utch or G erman. Incremental cost‐effectiveness ratios of the interventions were up‐rated to 2013 US $ using P urchasing P ower P arity conversion rates and C onsumer P rice I ndices. The quality of included studies was assessed using the E xtended C onsensus on H ealth E conomic C riteria L ist. Twelve out of the 1681 retrieved records fulfilled the inclusion criteria. They reported only on one aspect of hyperphosphataemia management, which is the use of phosphate binders (calcium‐based and calcium‐free, in first‐line and sequential use). No economic evaluations of other phosphorus‐lowering interventions were found. The included articles derived from five countries and most of them were funded by pharmaceutical companies. The incremental cost‐effectiveness ratios of phosphate binders ranged between US $11 461 and US $157 760 per quality‐adjusted life‐year gained. Calcium‐based binders (especially calcium acetate) appear to be the optimal cost‐effective first‐ and second‐line therapy in prevalent patients, while the calcium‐free binder, lanthanum carbonate, might provide good value for money, as second‐line therapy, in incident patients. The studies' overall quality was suboptimal. Drawing firm conclusions was not possible due to the quality heterogeneity and inconsistent results. Future high‐quality economic evaluations are needed to confirm the findings of this review and to address other interventions to manage hyperphosphataemia in this population.