P171
COST ANALYSIS OF SWITCHING FROM SEVELAMER CARBONATE TO
LANTHANUM CARBONATE MONOTHERAPY IN THE UK
Morison, B,1 Wilson, RJ,2 Keith, MS,3 Copley, JB3
1
Shire Pharmaceuticals, Basingstoke, UK; 2Spica Consultants, Marlborough, UK; 3Shire,
Wayne, PA, USA
INTRODUCTION: Real-world data from end-stage renal disease (ESRD) patient populations
have demonstrated that control of hyperphosphataemia tends to be similar between patients who
are treated with sevelamer and those treated with lanthanum carbonate (LC) because both
treatments can be titrated to achieve pre-specified phosphate levels. The drug dosage and
relative costs of sevelamer and LC are therefore important differentiating factors to consider in
the overall management of patients with ESRD. In the UK, sevelamer carbonate (SC) and LC
are now available as powder formulations. The aim of this evaluation was to conduct a cost
analysis of switching patients with ESRD in the UK from SC to LC monotherapy using UKspecific powder formulation drug costs.
METHODS: UK mean drug doses and patient utilization data were obtained from the online
market tracking tool ‘TherapyWatch’ (Research Partnership, data accessed Mar 2012–Oct
2013). The mean doses of SC and LC may include both monotherapy and combination therapy.
The relative costs of daily clinical doses of SC and LC were calculated using UK drug prices as
follows: SC powder: £2.36 per 2400 mg; LC powder £2.15 per 1000 mg (NHS prices, May
2013).
RESULTS: The mean doses of SC and LC powder formulations in the UK are 5660 mg/day (n
= 105) and 2680 mg/day (n = 24), respectively. LC has only recently become available as a
powder formulation in the UK (2012); however, the mean dose of the powder formulation is
similar to that of the LC tablet formulation (2390 mg/day; n = 538). Although the mean dose of
LC in the UK is approximately 2600 mg/day, we adopted a conservative approach for cost
comparisons by using a slightly increased dose of LC 3000 mg/day. Powder formulation cost
assessments indicate that for doses of SC 7200 mg/day (£7.08/day) and above, LC 3000 mg/day
(£6.45/day) becomes the less expensive option of the two binders. Patient utilization data
(TherapyWatch, data accessed Mar 2012–Oct 2013) indicated that approximately 56% of
patients taking SC in a powder formulation in the UK receive doses of ≥ 7200 mg/day. The
annual cost saving of switching a patient from SC 7200 mg/day and 9600 mg/day to LC 3000
mg/day could be approximately £230 and £1092 per patient per year, respectively.
CONCLUSIONS: Our analysis indicates that LC 3000 mg/day is less costly than SC ≥ 7200
mg/day, based upon UK prices of powder formulations. For the patients in the UK that receive
SC ≥ 7200 mg/day as a powder formulation (~56% of patients), switching phosphate binder
therapy to LC offers the potential of drug cost savings and similar phosphate control. Both LC
and SC have demonstrated acceptable safety profiles.