Estimating hospital inpatient cost-savings with sucroferric oxyhydroxide in patients on chronic hemodialysis in five European countries: a cost analysis

Figures & data

Table 1. Equations for: (1) mean incidence rate of hospital admissions, (2) cost per admission in the five European countries, (3) inpatient cost-savings per patient per year, (4) incremental phosphate binder drug costs, and (5) net economic effect.

Equations
1	${\mathrm{ }\overline{IR}}_{j\mathrm{ }}=\mathrm{ }\frac{1}{n}{\sum }_{i=1}^n\frac{{\mathit{Hospital}\mathrm{ }\mathit{admissions}}_i}{{\mathit{Patient}\mathrm{ }\mathit{years}\mathrm{ }\mathit{lived}}_i}\mathrm{ }$
2	${\mathit{InC}}_{jk}\mathrm{ }=\mathrm{ }{\mathrm{ }\overline{IR}}_{j\mathrm{ }}\times \mathrm{ }{HC}_k$
3	Inpatient cost – difference (cost – savings) per patient k (per scope country k) = InC mSO k – InC dSO k
4	Incremental phosphate binder drug costs (drug costs difference) per patient k (per scope country k) = (Annual drug costs per patient mSO k – Annual drug costs per patient dSO k)
5	Net economic effect (per scope country k) = Inpatient cost-savings per patient k (benefit) – Incremental phosphate binder drug costs per patient k (costs)

Abbreviations. ${ \overline{IR}}_j,$ Mean incidence rate of hospital admissions per patient per study group (j); j, Study group (mSO or dSO); n, Population in each study group; i, Study subjects; k, Scope country; InC_jk, Inpatient costs per patient, per study group (j) and per scope country (k); HC_k, Cost per hospital admission per scope country (k).

Table 2. Inpatient costs: cost per hospital admission.

Country	Description of inpatient cost input	Cost per hospital admission in 2020 prices adjusted for purchasing parity prices (PPPs)
France	The economic evaluation report of Haute Autorité de Santé for ESRD in France (2014) reported the average monthly cost of “all other hospitalizations” for patients treated with in-center dialysis and the average hospital admissions per year. Subsequently, cost of “other hospitalizations” per dialyzed patients was deduced.	€3,374^32
Germany	Obtained from a retrospective study assessing the costs of CKD patients at stages 3 and 4 and on dialysis in Germany. Patients on HD or PD incurred annual, all-cause hospitalization costs of €10,029. The annual number of hospital admissions per patient was 1.9 admissions, which results in a cost per hospital admission of €5,890.	€5,890^33
Italy	The study by Roggeri et al. reported weighted average costs per hospital admission (in 2011 prices) in the Piedmont region. The study collected cost data for all-cause hospital admissions for patients undergoing HD or PD.	€5,783^34
Spain	DRG code 460 for renal insufficiency.	€4,246^35
UK	Observed costs by CKD stage and by comorbidity were reported in the “Study of Heart and Renal Protection” (SHARP), a randomized trial that prospectively collected information on kidney disease progression, serious adverse events, and hospital care use in patients with moderate-to-severe CKD. The cost used was the incremental cost per hospital admission for a major vascular event for patients on HD.	€8,231^36

Abbreviations. CKD, chronic kidney disease; DRG, diagnosis-related group; ESRD, end-stage renal disease; HD, hemodialysis; PD, peritoneal dialysis.

Table 3. Estimated annual drug costs, inpatient costs, and total annual costs per patient between treatment groups per country (all admissions analysis [EUR 2020]).

	Annual PB drug costs per patient*			Annual inpatient costs per patient			Total annual costs per patient
Country	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Incremental drug costs (drug costs difference) per patient	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Inpatient cost difference per patient**	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Net economic effect***
France	€1,763	€889	€874	€3,654	€4,855	−€1,201	€5,416	€5,743	−€327
Germany	€2,508	€1,996	€512	€6,379	€8,476	−€2,097	€8,888	€10,472	−€1,585
Italy	€1,949	€913	€1,036	€6,263	€8,322	−€2,059	€8,212	€9,235	−€1,022
Spain	€1,414	€1,003	€411	€4,599	€6,110	−€1,512	€6,013	€7,114	−€1,100
UK	€2,622	€1,758	€864	€9,334	€12,402	−€3,068	€11,957	€14,161	−€2,204

*Drug costs and inpatient costs were adjusted for PPPs.

**Calculated based on incidence rate of hospital admissions per patient, per year: SO: 1.08; other PBs: 1.44 from Coyne et al.²⁸

***Positive values suggest additional drug costs for the mSO group.

Abbreviations. dSO, patients who discontinued sucroferric oxyhydroxide and were treated with non-sucroferric oxyhydroxide phosphate binder; mSO, patients who received 2 years of maintenance therapy with sucroferric oxyhydroxide; PB, phosphate binder.

Table 4. Estimated annual drug costs, inpatient costs, and total annual costs between treatment groups per country (admissions analysis > 24 h [EUR 2020]).

	Annual PB drug costs per patient*			Annual inpatient costs per patient			Total annual costs per patient
Country	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Incremental drug costs (drug costs difference) per patient	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Inpatient cost difference per patient**	Mono-therapy SO (mSO)	Patients switching to other PBs (dSO)	Net economic effect***
France	€1,763	€889	€874	€3,097	€4,433	−€1,336	€4,860	€5,322	−€462
Germany	€2,508	€1,996	€512	€5,407	€7,740	−€2,333	€7,916	€9,736	−€1,820
Italy	€1,949	€913	€1,036	€5,309	€7,599	−€2,290	€7,258	€8,512	−€1,254
Spain	€1,414	€1,003	€411	€3,898	€5,580	−€1,682	€5,313	€6,583	−€1,270
UK	€2,622	€1,758	€864	€7,912	€11,325	−€3,413	€10,534	€13,083	−€2,549

*Drug costs and inpatient costs were adjusted for PPPs.

**Calculated based on incidence rate of hospital admissions per patient, per year: SO: 0.92; other PBs: 1.31 from Coyne et al.²⁸

***Positive values suggest additional drug costs for the mSO group.

Abbreviations. dSO, patients who discontinued sucroferric oxyhydroxide and were treated with non-sucroferric oxyhydroxide phosphate binder; mSO, patients who received 2 years of maintenance therapy with sucroferric oxyhydroxide; PB, phosphate binder.

Table 5. One-way sensitivity analysis for the net economic effect* (all admissions).

	Sensitivity analysis for the difference in the incidence of admissions**		Sensitivity analysis for the difference in annual PB drug costs
All admissions	Minimum	Maximum	−10%	10%
France	€273	−€762	−€415	−€240
Germany	−€536	−€2,345	−€1,636	−€1,533
Italy	€7	−€1,768	−€1,126	−€919
Spain	−€345	−€1,648	−€1,142	−€1,059
UK	−€670	−€3,316	−€2,290	−€2,118

*Positive values suggest additional drug costs for the mSO group.

**All admissions incidence rate difference adjusted for covariates: Mean (95% CI): −35.6 (−17.8, −48.5) per 100 patient-years.

Abbreviations. CI, confidence interval; mSO, patients who received 2 years of maintenance therapy with sucroferric oxyhydroxide; PB, phosphate binder.

Table 6. One-way sensitivity analysis for the net economic effect* (admissions > 24 h).

	Sensitivity analysis for the difference in the incidence of admissions**		Sensitivity analysis for the difference in annual PB drug costs
All admissions	Minimum	Maximum	−10%	10%
France	€115	−€907	−€550	−€375
Germany	−€813	−€2,598	−€1,872	−€1,769
Italy	−€265	−€2,017	−€1,357	−€1,150
Spain	−€544	−€1,831	−€1,311	−€1,229
UK	−€1,075	−€3,686	−€2,635	−€2,462

*Positive values suggest additional drug costs for the mSO group.

**Admissions > 24 h incidence rate adjusted for covariates: Mean (95% CI): −39.6 (−22.5, 52.8) per 100 patient-years.

Abbreviations. CI, confidence interval; mSO, patients who received 2 years of maintenance therapy with sucroferric oxyhydroxide; PB, phosphate binder.

HAS. Évaluation médico-économique des stratégies de prise en charge de l’insuffisance rénale chronique terminale en France 2014. Available from: https://www.has-sante.fr/portail/upload/docs/application/pdf/2014-11/argumentaire_irct_vf_2014-11-06_19-21-13_876.pdf#page=104&zoom=100,0,328.

 Google Scholar

Gandjour A, Armsen W, Wehmeyer W, et al. Costs of patients with chronic kidney disease in Germany. PLoS One. 2020;15(4):e0231375.

 PubMed Web of Science ®Google Scholar

Roggeri P, Roggeri A, Salomone M. Chronic kidney disease: Evolution of healthcare costs and resource consumption from predialysis to dialysis in Piedmont region, Italy. Advances in Nephrology. 2014;2014:1–6.

 Google Scholar

MSCBS. NORMA ESTATAL APR-GRD Hospitales de agudos - BASAL 2017. [cited 20 February 2020]. Available from: https://www.mscbs.gob.es/estadEstudios/estadisticas/cmbd.htm.

 Google Scholar

Kent S, Schlackow I, Lozano-Kühne J, et al. What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrol. 2015;16:65.

 PubMed Web of Science ®Google Scholar

Coyne DW, Ficociello LH, Parameswaran V, et al. Sucroferric oxyhydroxide in maintenance hemodialysis: a retrospective, comparative cohort study. Kidney Med. 2020;2(3):307–316.

 PubMedGoogle Scholar