Ferric citrate has been shown to be efficacious as a phosphate binder in end-stage renal disease patients receiving hemodialysis and also results in reduced utilization of erythropoiesis-stimulating agents and intravenous iron, higher hemoglobin levels, and lower hospitalization rates.

Using a Markov microsimulation model, we show that under the current reimbursement paradigm, use of ferric citrate as a first-line phosphate binder is associated with a base-case cost savings of approximately US$213,223/year per 100 patients treated compared with standard of care.

Cost savings arise principally from reductions in erythropoiesis-stimulating agent and intravenous iron utilization and in the number of hemodialysis sessions missed as a result of hospitalizations.