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Sevelamer for the Treatment of Patients with Chronic Kidney Disease: A Review of Clinical and Cost-Effectiveness

Last updated: September 21, 2016
Project Number: RC0810-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of sevelamer for the treatment of patients with chronic kidney disease?
  2. What is the cost-effectiveness of sevelamer for the treatment of patients with chronic kidney disease?

Key Message

Overall, the evidence suggests that sevelamer is more effective at reducing serum calcium levels and lowering the attendant risk of hypercalcemia in patients with CKD stages 3 to 5D compared to calcium-based phosphate binders, but may be less effective at lowering serum phosphate levels. The results on the impact of sevelamer on vascular calcification are mixed. With respect to safety, sevelamer may be more effective at reducing the risks of all-cause mortality and cardiovascular mortality in patients with CKD stages 3 to 5D relative to calcium-based phosphate binders. Sevelamer increases the risk of diarrhea, constipation, abdominal bloating, and combined gastrointestinal events. The trends are statistically significant for constipation, and combined gastrointestinal events. The evidence on nausea is mixed. There is no evidence on the safety of sevelamer relative to calcium-based phosphate binders specific to patients with non-dialysis-dependent (NDD)-CKD.Sevelamer is cost-effective relative to calcium carbonate based on a range of willingness-to-pay (WTP) ratios and a variety of hypothetical and patient-based scenarios involving patients in CKD stages 3 to 5D. In addition, sevelemar is cheaper and more clinically effective than calcium-carbonate in all scenarios involving a subset of pre-dialysis or NDD-CKD patients.