A review of the work undertaken by ScHARR. Assessing the cost effectiveness of lanthanum carbonate as a secondline treatment for patients who were inadequately controlled using acceptable levels of the phosphate binder calcium carbonate. The clinical pathways used in the model follow the structure detailed below.

• Patients who failed to have an adequately controlled phosphate level on calcium carbonate received a trial period on lanthanum carbonate.

• Those who succeeded on lanthanum carbonate continued to receive it.

• Those who failed on lanthanum carbonate switched back to calcium carbonate.

• Serum phosphorus levels were estimated for each subgroup using clinical trial results.

• Implied relative risks of mortality (Block et al) were applied to United States Renal Data System (USRDS) survival data, and thus the qualityadjusted life-years (QALYs) gained were calculated.

• The costs of treatment were attached to each pathway.