[Kidney and bone update : the 5-year history and future of CKD-MBD. Pharmacoeconomics in the field of CKD-MBD].

Pharmacoeconomics (PE) , which contributes to the decisions on the population rather than the patient level such as policy making, provides us with the cost and value of a given drug. Recent Japanese PE studies in the field of CKD-MBD are reviewed in this manuscript. Lanthnum carbonate is not cost effective as a first-line phosphate binder, while cost effective as a second-line drug added on conventional treatments for those with serum phosphate >6.0 mg/dL, as shown in incremental cost-effectiveness ratio (ICER) of $34,896. Cinacalcet hydrochloride was found to be cost effective only for those who cannot undergo parathyroidectomy. Taking these findings into account, when cinacalcet have to be used, we should give priority to calcium containing phosphate binders rather than expensive sevelamer or lanthanum from the viewpoint of the medical cost. Moreover, the doses of cinacalcet should be minimized by administering inexpensive vitamin D concomitantly.