Approximately 75% of dialysis patients are on phosphate binders for the treatment of elevated serum phosphorus levels or hyperphosphatemia.1 The iron-based phosphate binder Velphoro (sucroferric oxyhydroxide), with a starting dose of 3 chewable pills per day, received U.S. Food and Drug Administration approval, and EU marketing authorization from the European Commission, in November 2013 and August 2014, respectively, to control serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. Results from a 52-week Phase III trial demonstrated that Velphoro was non-inferior to the current gold standard, the sevelamer-based phosphate binder Renvela (sevelamer carbonate), in maintaining serum phosphorus levels with a fewer mean pill number (3.3 vs. 8.7).
At the recent International Society for Pharmacoeconomics and Outcomes Research (ISPOR) conference in November 2016 in Vienna, Connolloy M. et al shared their analysis on the cost per responder for Velphoro versus Renvela in patients on hemodialysis in Europe.3 Results suggest that Velphoro was able to attain the clinical target of in-range serum phosphorus levels (3.5 – 5.5 mg/dL) at a lower cost compared with Renvela, demonstrating cost-effectiveness. In addition, the cost per responder was consistently favorable for Velphoro even when the relative pill burden and acquisition costs of the two phosphate binders were varied.
Despite Velphoro’s comparable efficacy and significantly reduced pill burden compared with Renvela, our CurrentTreatment® Bone and Mineral Metabolism Q3 2016 (US) study based on responses from 100 nephrologsts1 suggests that Velphoro uptake in the United States has been slow since its approval. Nephrologists report that only 7% of their dialysis patients are on Velphoro. Physician comfort in prescribing efficacious Renvela over the last decade, their perception that phosphate binder-treated patients would prefer pills to be swallowed over chewable tablets, concerns over the long-term safety of Velphoro, and the cost-based challenges associated with partnering with dialysis chains are some of the obstacles to Velphoro’s uptake in the U.S., and contribute to Renvela’s continued dominance of hyperphosphatemia treatment. However, in light of this new data suggesting cost-effectiveness of Velphoro over Renvela, dialysis chains and physicians alike may be encouraged to carry and increase prescriptions for Velphoro, respectively.
1 Decision Resources Group’s CurrentTreatment® Bone and Mineral Metabolism Q3 2016 (US) provides a deep dive and longitudinal information on the bone and mineral metabolism (BMM) disorder market dynamics. It examines the management of dialysis and mid-to late-stage CKD patients from the perspective of 100 U.S. nephrologists with emphasis on hyperphosphatemia, secondary hyperparathyroidism (SHPT), and hyperkalemia. Also included in this content are sales and messaging efforts of key market players and coverage of late-stage products for the treatment of BMM.
2 Jürgen F., et al. Long-term effects of iron-based phosphate binder, sucroferric oxyhydroxide, in dialysis patients. Nephrol. Dial. Transplant. 29, 2092-2099, 2014.
3 Connolloy M. et al. Cost per responder analysis of sucroferric oxyhydroxide versus sevelamer carbonate in patients on hemodialysis in Europe. Poster at the ISPOR Conference Vienna, November 2016.