Tags

Type your tag names separated by a space and hit enter

The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective.
Nephrol Dial Transplant. 2007 May; 22(5):1428-36.ND

Abstract

BACKGROUND

Secondary hyperparathyroidism (SHPT) is a common side effect of end-stage renal disease (ESRD) and is associated with increased risk of fracture and cardiovascular events (CV). Current standard treatment includes dietary control, phosphate binders and vitamin D. However, many patients do not have their parathyroid hormone (PTH), calcium and phosphate levels controlled by this regimen. Cinacalcet is the first of a new class of calcimimetic drugs which suppress PTH production. Although there is convincing evidence of the impact of cinacalcet on serum biomarkers, the long-term clinical implications of treatment are less clear. The aim of this study is to estimate the cost-utility of cinacalcet as an addition to standard treatment of SHPT compared with standard treatment alone.

METHODS

A Markov model was developed to estimate the incremental cost-utility of cinacalcet. Uncertainty was explored through extensive sensitivity analysis.

RESULTS

Compared with standard treatment, cinacalcet incurs average additional lifetime costs of pound21,167 per person and confers an additional 0.34 quality adjusted life years, resulting in an incremental cost-effectiveness ratio of pound61,890 (approximately euro89,000) per quality-adjusted life-year (QALY). Extensive one-way sensitivity analysis showed that cinacalcet was only likely to be considered cost-effective if the relative risk of mortality for people with very high levels of PTH was 2.2 compared with people whose PTH reached target levels, or if drug costs were considerably reduced. Probabilistic sensitivity analysis showed cinacalcet was very unlikely to be cost-effective at usual levels of willingness to pay in the National Health Service (NHS).

CONCLUSION

Unless the cost of cinacalcet is considerably reduced, it is unlikely to be considered a cost-effective treatment for people with SHPT.

Authors+Show Affiliations

Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, and Noy Scott House, Royal Devon & Exeter Hospital, Barrack Road Exeter, EX2 5DW, UK. Ruth.Garside@PenTAG.nhs.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17308322

Citation

Garside, Ruth, et al. "The Cost-utility of Cinacalcet in Addition to Standard Care Compared to Standard Care Alone for Secondary Hyperparathyroidism in End-stage Renal Disease: a UK Perspective." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 22, no. 5, 2007, pp. 1428-36.
Garside R, Pitt M, Anderson R, et al. The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective. Nephrol Dial Transplant. 2007;22(5):1428-36.
Garside, R., Pitt, M., Anderson, R., Mealing, S., D'Souza, R., & Stein, K. (2007). The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 22(5), 1428-36.
Garside R, et al. The Cost-utility of Cinacalcet in Addition to Standard Care Compared to Standard Care Alone for Secondary Hyperparathyroidism in End-stage Renal Disease: a UK Perspective. Nephrol Dial Transplant. 2007;22(5):1428-36. PubMed PMID: 17308322.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cost-utility of cinacalcet in addition to standard care compared to standard care alone for secondary hyperparathyroidism in end-stage renal disease: a UK perspective. AU - Garside,Ruth, AU - Pitt,Martin, AU - Anderson,Rob, AU - Mealing,Stuart, AU - D'Souza,Richard, AU - Stein,Ken, Y1 - 2007/02/17/ PY - 2007/2/20/pubmed PY - 2007/8/10/medline PY - 2007/2/20/entrez SP - 1428 EP - 36 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 22 IS - 5 N2 - BACKGROUND: Secondary hyperparathyroidism (SHPT) is a common side effect of end-stage renal disease (ESRD) and is associated with increased risk of fracture and cardiovascular events (CV). Current standard treatment includes dietary control, phosphate binders and vitamin D. However, many patients do not have their parathyroid hormone (PTH), calcium and phosphate levels controlled by this regimen. Cinacalcet is the first of a new class of calcimimetic drugs which suppress PTH production. Although there is convincing evidence of the impact of cinacalcet on serum biomarkers, the long-term clinical implications of treatment are less clear. The aim of this study is to estimate the cost-utility of cinacalcet as an addition to standard treatment of SHPT compared with standard treatment alone. METHODS: A Markov model was developed to estimate the incremental cost-utility of cinacalcet. Uncertainty was explored through extensive sensitivity analysis. RESULTS: Compared with standard treatment, cinacalcet incurs average additional lifetime costs of pound21,167 per person and confers an additional 0.34 quality adjusted life years, resulting in an incremental cost-effectiveness ratio of pound61,890 (approximately euro89,000) per quality-adjusted life-year (QALY). Extensive one-way sensitivity analysis showed that cinacalcet was only likely to be considered cost-effective if the relative risk of mortality for people with very high levels of PTH was 2.2 compared with people whose PTH reached target levels, or if drug costs were considerably reduced. Probabilistic sensitivity analysis showed cinacalcet was very unlikely to be cost-effective at usual levels of willingness to pay in the National Health Service (NHS). CONCLUSION: Unless the cost of cinacalcet is considerably reduced, it is unlikely to be considered a cost-effective treatment for people with SHPT. SN - 0931-0509 UR - https://www.unboundmedicine.com/medline/citation/17308322/The_cost_utility_of_cinacalcet_in_addition_to_standard_care_compared_to_standard_care_alone_for_secondary_hyperparathyroidism_in_end_stage_renal_disease:_a_UK_perspective_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfl774 DB - PRIME DP - Unbound Medicine ER -