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Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States.
J Med Econ. 2012; 15(3):509-20.JM

Abstract

OBJECTIVE

Cinacalcet has been used in controlling secondary hyperparathyroidism (SHPT) in dialysis patients since 2004, but its full economic evaluation has not been conducted from the US perspective. This study assesses the cost-effectiveness of cinacalcet and low-dose vitamin D for the treatment of SHPT in dialysis patients compared with flexible vitamin D.

METHODS

A lifetime patient-level simulation model was developed using ADVANCE trial data, including biomarker levels: parathyroid hormone, calcium, and phosphorus. The impact of the biomarkers on mortality, cardiovascular events, fractures, and parathyroidectomy were estimated from literature: Block, an observational study; Cunningham, a combined analysis of four randomized trials of cinacalcet; and Danese, a study investigating the effect of duration in recommended targets. Baseline event rates were derived from the large dialysis organizations registries. One-way and probabilistic sensitivity analyses (PSA) were conducted.

RESULTS

The cost-effectiveness ratio for cinacalcet compared with standard of care (vitamin D and phosphate binders) was $54,560 and $72,456/quality-adjusted-life-year (QALY) gained or an incremental cost of $3155 and $2638 per year alive for the Block and Danese variants, respectively. In the Cunningham variant, cost-effectiveness ratio for cinacalcet was $5064/QALY gained or a cost saving of $1068 per year. The difference in the results of the Cunningham variant vs other variants can be explained by the favorable impact of cinacalcet on outcomes, specifically cardiovascular events observed in the Cunningham study. The PSA showed 98% likelihood for cinacalcet to be cost-effective at $100,000/QALY threshold.

LIMITATIONS

Observational data assessing effects on clinical outcomes, trial restriction to use calcium-containing phosphate binders, no utility data in SHPT dialysis population, and insufficient evidence on long-term impact of cinacalcet and vitamin D on biochemical markers.

CONCLUSIONS

Cinacalcet treatment is cost-effective for treatment of SHPT in the US. Due to cost offsets, cinacalcet can reduce annual costs in some scenarios.

Authors+Show Affiliations

Cerner LifeSciences, Beverly Hills, CA, USA. rob.boer@cerner.comNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22313328

Citation

Boer, Rob, et al. "Cost-effectiveness of Cinacalcet in Secondary Hyperparathyroidism in the United States." Journal of Medical Economics, vol. 15, no. 3, 2012, pp. 509-20.
Boer R, Lalla AM, Belozeroff V. Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States. J Med Econ. 2012;15(3):509-20.
Boer, R., Lalla, A. M., & Belozeroff, V. (2012). Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States. Journal of Medical Economics, 15(3), 509-20. https://doi.org/10.3111/13696998.2012.664799
Boer R, Lalla AM, Belozeroff V. Cost-effectiveness of Cinacalcet in Secondary Hyperparathyroidism in the United States. J Med Econ. 2012;15(3):509-20. PubMed PMID: 22313328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of cinacalcet in secondary hyperparathyroidism in the United States. AU - Boer,Rob, AU - Lalla,Anjana M, AU - Belozeroff,Vasily, Y1 - 2012/02/21/ PY - 2012/2/9/entrez PY - 2012/2/9/pubmed PY - 2012/9/1/medline SP - 509 EP - 20 JF - Journal of medical economics JO - J Med Econ VL - 15 IS - 3 N2 - OBJECTIVE: Cinacalcet has been used in controlling secondary hyperparathyroidism (SHPT) in dialysis patients since 2004, but its full economic evaluation has not been conducted from the US perspective. This study assesses the cost-effectiveness of cinacalcet and low-dose vitamin D for the treatment of SHPT in dialysis patients compared with flexible vitamin D. METHODS: A lifetime patient-level simulation model was developed using ADVANCE trial data, including biomarker levels: parathyroid hormone, calcium, and phosphorus. The impact of the biomarkers on mortality, cardiovascular events, fractures, and parathyroidectomy were estimated from literature: Block, an observational study; Cunningham, a combined analysis of four randomized trials of cinacalcet; and Danese, a study investigating the effect of duration in recommended targets. Baseline event rates were derived from the large dialysis organizations registries. One-way and probabilistic sensitivity analyses (PSA) were conducted. RESULTS: The cost-effectiveness ratio for cinacalcet compared with standard of care (vitamin D and phosphate binders) was $54,560 and $72,456/quality-adjusted-life-year (QALY) gained or an incremental cost of $3155 and $2638 per year alive for the Block and Danese variants, respectively. In the Cunningham variant, cost-effectiveness ratio for cinacalcet was $5064/QALY gained or a cost saving of $1068 per year. The difference in the results of the Cunningham variant vs other variants can be explained by the favorable impact of cinacalcet on outcomes, specifically cardiovascular events observed in the Cunningham study. The PSA showed 98% likelihood for cinacalcet to be cost-effective at $100,000/QALY threshold. LIMITATIONS: Observational data assessing effects on clinical outcomes, trial restriction to use calcium-containing phosphate binders, no utility data in SHPT dialysis population, and insufficient evidence on long-term impact of cinacalcet and vitamin D on biochemical markers. CONCLUSIONS: Cinacalcet treatment is cost-effective for treatment of SHPT in the US. Due to cost offsets, cinacalcet can reduce annual costs in some scenarios. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/22313328/Cost_effectiveness_of_cinacalcet_in_secondary_hyperparathyroidism_in_the_United_States_ L2 - https://www.tandfonline.com/doi/full/10.3111/13696998.2012.664799 DB - PRIME DP - Unbound Medicine ER -