Phosphorus binding with ferric citrate is associated with fewer hospitalizations and reduced hospitalization costs

Abstract

Background: Ferric citrate (FC) is a new phosphorus binder shown to increase serum iron stores while reducing intravenous iron and erythropoiesis-stimulating agent usage. Such reductions could lower hospitalization rates and associated costs. Methods: Hospitalizations during a Phase III trial were compared between FC and active control (AC). Hospitalization costs were estimated using the 2013 US Renal Data System Annual Data Report. Results: 34.6% of FC patients were hospitalized at least once versus 45.6% of the AC group (risk reduction 24.2%; p = 0.02). There were 181 unique hospitalizations in the FC group versus 239 in the AC group, for a difference of 58 hospitalizations. Total potential savings was US$ 867,622 in hospitalization costs in the FC group. If the hospitalization reduction in our study was applied to the general end-stage renal disease population, this could translate into a savings of US$ 3002/patient/year. Conclusions: Patients receiving FC experienced fewer hospitalizations with the potential for significant savings.

Keywords:

• costs
• dialysis
• end-stage renal disease
• erythropoiesis-stimulating agent
• ferric citrate
• hospitalization
• iron

Financial & competing interests disclosure

The study was funded by Keryx Biopharmaceuticals, Inc. All the authors declare that they have received research grants from or acted as a consultant to Keryx, and received travel support from Keryx. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Ferric citrate (FC) is a new and unique phosphorus binder, which in a Phase III clinical trial of 441 dialysis subjects over a 52-week active control (AC) period provided similar phosphorus control while increasing serum iron stores when compared with an AC group using sevelamer carbonate and/or calcium acetate.

• This effect of FC on iron stores led to a significant reduction in intravenous iron (median 1.85 mg/day FC, 3.84 mg/day AC, p < 0.001) and erythropoiesis-stimulating agent (median epoetin equivalent units/day: FC, 758 vs AC, 993, p = 0.043) usage in the FC group while maintaining hemoglobin levels.

• Because both intravenous iron usage and erythropoiesis-stimulating agent dose have been linked to morbidity, a reduction in either agent could result in decreased hospitalization rates that would translate into subsequent cost savings.

• On the basis of our analysis, based on the aforementioned Phase III trial, we found that 34.6% of the FC patients were hospitalized at least once during the trial compared with 45.6% of the AC group (risk reduction 24.1%, p = 0.02).

• Adjusting for the 2:1 FC to AC study subject randomization, there were 181 unique hospitalizations in the FC group compared with 239 in the AC group for a difference of 58 hospitalizations. At US$ 14,959/admission, this translates into a total potential savings of US$ 867,622 in hospitalization costs in the FC group.

• If the reduction in hospitalization events seen in our study subjects taking FC was to be applied to the general ESRD population, and if it was to persist beyond the 52-week study period, this could translate into a savings of US$ 3002/patient per year.

• Overall, patients receiving FC experienced fewer hospitalizations with the potential for significant savings. Results from this analysis are important, given the high cost of treating patients with ESRD.