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. 2013 Apr 30:6:79-87.
doi: 10.2147/IJNRD.S40729. Print 2013.

Reduced use of erythropoiesis-stimulating agents and intravenous iron with ferric citrate: a managed care cost-offset model

Richard Mutell  1 , Jaime L Rubin, T Christopher Bond, Tracy Mayne
Affiliations

Reduced use of erythropoiesis-stimulating agents and intravenous iron with ferric citrate: a managed care cost-offset model

Richard Mutell et al. Int J Nephrol Renovasc Dis. .

Abstract

Background: Ferric citrate (FC) is a phosphate binder in development for the treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). In clinical trials, FC improved patient serum phosphorus levels and increased serum ferritin and percent transferrin saturation. Because nephrologists respond to increases in these iron measures by reducing intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) doses, the decreased use of iron and ESA associated with FC may reduce costs.

Objectives: To develop a cost-offset model from a managed care perspective estimating the cost savings associated with FC use.

Methods: We created a cost-offset model from the managed care payer perspective that compared the treatment costs of ESRD for patients given FC. The model considered the number of dialysis sessions per month; number of ESRD patients enrolled in the health plan; cost of ESAs, iron, and dialysis sessions; and the proportion of patients on phosphate binder therapy. The model assumed equivalent efficacy and cost neutrality between FC and other phosphate binders. Monte Carlo simulations were conducted by varying model inputs.

Results: When FC was compared to other phosphate binders, the monthly cost of ESA and IV iron per 500 patients with ESRD (85% treated with phosphate binders) was reduced by 8.15% and 33.2%, respectively. When incorporated into the total cost of dialysis for patients with ESRD (dialysis, ESA, and IV iron), the decrease in the monthly cost of dialysis care was US$80,214 per 500 ESRD patients. Monte Carlo simulations suggest that a plan serving 500 dialysis patients could save between US$626,000 and US$1,106,000 annually with the use of FC.

Conclusion: The use of FC in ESRD patients with hyperphosphatemia may help reduce treatment costs.

Keywords: dialysis; end-stage renal disease; hemodialysis; hyperphosphatemia; phosphate binders.

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Figures

Figure 1
Figure 1
Base model values and distributions for different model parameters used in the Monte Carlo simulations. (A) the number of patients with end-stage renal disease in the plan, comparison with normal (500, 50) (B) percent on binder therapy; comparison with triang (0.765, 0.85, 0.935). (C) Average number of dialysis sessions per month; comparison with normal (11.95, 2.14, risk truncate, [14]). (D) EPO payment per 1000 units; comparison with triang (15, 20, 22). (E) Iron payment per mg; comparison with triang (0.75, 1, 1.25). Note: All figures are in US dollars. Abbreviations: EPO, epoetin alfa; std dev, standard deviation; triang, triangle distribution.
Figure 1
Figure 1
Base model values and distributions for different model parameters used in the Monte Carlo simulations. (A) the number of patients with end-stage renal disease in the plan, comparison with normal (500, 50) (B) percent on binder therapy; comparison with triang (0.765, 0.85, 0.935). (C) Average number of dialysis sessions per month; comparison with normal (11.95, 2.14, risk truncate, [14]). (D) EPO payment per 1000 units; comparison with triang (15, 20, 22). (E) Iron payment per mg; comparison with triang (0.75, 1, 1.25). Note: All figures are in US dollars. Abbreviations: EPO, epoetin alfa; std dev, standard deviation; triang, triangle distribution.
Figure 2
Figure 2
Monte Carlo simulations of (A) cost savings per patient per month and (B) total monthly savings with ferric citrate. Note: All figures are in US dollars. Abbreviations: PPPM, per patient per month; std dev, standard deviation.
Figure 3
Figure 3
Monte Carlo simulations of annual savings with ferric citrate. Note: All figures are in US dollars. Abbreviation: std dev, standard deviation.
Figure 4
Figure 4
Sensitivity analysis. Note: All figures are in US dollars. Abbreviation: ESA, erythropoiesis-stimulating agent.
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References

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