番茄社区

The type of phosphate binder utilized in dialysis patients may affect rate of hospitalizations, researchers reported.

In an analysis of Medicare beneficiaries on dialysis, patients prescribed sucroferric oxyhydroxide (Velphoro) had lower hospital admission rates compared with patients who received four other phosphate binders (7.97 per 100 member months), according to Kristain Lindemann, of Fresenius Health Partners in Waltham, Massachusetts, and colleagues.

Per 100 member months, hospital admission rates were highest for calcium acetate (Eliphos, PhosLo) at 11.28, followed by sevelamer (Renagel, Renvela) at 10.52, ferric citrate (Auryxia) at 9.54, and lanthanum carbonate (Fosrenol) with 8.86 admissions, they said in a at the National Kidney Foundation virtual Spring Clinical Meeting.

Compared with sucroferric oxyhydroxide, other phosphate binder therapy saw as much as a 42% higher hospital admission rate ratio:

• Calcium acetate: rate ratio 1.42 (95% CI 1.32-1.52)
• Sevelamer: RR 1.32 (95% CI 1.23-1.41)
• Ferric citrate: RR 1.20 (95% CI 1.09-1.31)
• Lanthanum carbonate: RR 1.11 (95% CI 0.99-1.25)

The authors also reported that total costs of care were lowest with use of sucroferric oxyhydroxide versus the other four binders assessed. When broken down by healthcare costs per member, patients treated with sucroferric oxyhydroxide averaged monthly costs of $5,670. Costs associated with ferric citrate were the second lowest, at monthly healthcare costs of around $5,908 per member.

Patients treated with lanthanum carbonate, calcium acetate, and sevelamer all averaged higher monthly healthcare costs at $6,104, $6,303, and $6,354, respectively.

Co-author Terry Ketchersid, MD, MBA, chief medical officer of then Integrated Care Group at Fresenius Medical Care North America told 番茄社区 he wasn't surprised by the findings.

"There is extensive data regarding the impact of pill burden on medication adherence. We also know that as binder adherence improves, serum phosphorus declines. Couple that with population studies showing an association with elevated phosphorus and higher admission rates, and the findings in our review are consistent with what we expected," he explained.

The study included 3-year patient data from 24 End Stage Renal Disease Seamless Care Organizations (ESCO), which coordinate dialysis treatment for more than 10% of Medicare patients on dialysis. All patients included had intact parathyroid levels under 600 pg/mL, and had phosphate binders prescribed between 2016 and 2018.

"We had access to the claims data as part of our participation in the ESCO," Ketchersid noted. "We were intrigued by the findings from in this area, and hoped to explore those results further within a program where success is defined by improving quality and reducing the cost of care."

He underscored that all healthcare providers should be aware that the choice of medication can make an impact for these patients on dialysis.

"Don't underestimate the importance of pill burden on medication adherence in patients with complex chronic conditions," he stated. "Choice of phosphate binder may help to reduce hospital admissions and overall costs of medical care."

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