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Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan.
Am J Kidney Dis. 2012 Aug; 60(2):262-71.AJ

Abstract

BACKGROUND

Cinacalcet effectively reduces elevated levels of parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (SHPT), even those with severe disease for whom parathyroidectomy can be the treatment of choice. The objective of this study was to estimate the cost-effectiveness of cinacalcet treatment in hemodialysis patients with severe SHPT in Japan.

STUDY DESIGN

Cost-effectiveness analysis.

SETTING & POPULATION

Patients with severe SHPT (intact PTH >500 pg/mL) who were receiving hemodialysis in Japan.

MODEL, PERSPECTIVE, & TIMEFRAME

A Markov model was constructed from the health care system perspective in Japan. Patients were followed up over their lifetime. Dialysis costs were not included in the base case.

INTERVENTION

Cinacalcet as an addition to conventional treatment compared to conventional treatment alone. In both arms, patients underwent parathyroidectomy if intact PTH level was >500 pg/mL for 6 months and they were eligible for surgery.

OUTCOMES

Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).

RESULTS

ICERs for cinacalcet for those who were eligible for surgery and those who were not were $352,631/QALY gained and $21,613/QALY gained, respectively. Sensitivity and scenario analyses showed that results were fairly robust to variations in model parameters and assumptions. In the probabilistic sensitivity analysis, cinacalcet was cost-effective in only 0.9% of simulations for those eligible for surgery, but in more than 99.9% of simulations for those ineligible for surgery, if society would be willing to pay $50,000 per additional QALY.

LIMITATIONS

Data for the long-term effect of cinacalcet on patient-level outcomes are limited. The model predicted rates for clinical events using data for the surrogate biochemical end points.

CONCLUSIONS

The use of cinacalcet to treat severe SHPT is likely to be cost-effective for only those who cannot undergo parathyroid surgery for medical or personal reasons.

Authors+Show Affiliations

Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22445709

Citation

Komaba, Hirotaka, et al. "Cost-effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients With Severe Secondary Hyperparathyroidism in Japan." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 60, no. 2, 2012, pp. 262-71.
Komaba H, Moriwaki K, Goto S, et al. Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan. Am J Kidney Dis. 2012;60(2):262-71.
Komaba, H., Moriwaki, K., Goto, S., Yamada, S., Taniguchi, M., Kakuta, T., Kamae, I., & Fukagawa, M. (2012). Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 60(2), 262-71. https://doi.org/10.1053/j.ajkd.2011.12.034
Komaba H, et al. Cost-effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients With Severe Secondary Hyperparathyroidism in Japan. Am J Kidney Dis. 2012;60(2):262-71. PubMed PMID: 22445709.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan. AU - Komaba,Hirotaka, AU - Moriwaki,Kensuke, AU - Goto,Shunsuke, AU - Yamada,Shunsuke, AU - Taniguchi,Masatomo, AU - Kakuta,Takatoshi, AU - Kamae,Isao, AU - Fukagawa,Masafumi, Y1 - 2012/03/24/ PY - 2011/09/15/received PY - 2011/12/30/accepted PY - 2012/3/27/entrez PY - 2012/3/27/pubmed PY - 2012/9/29/medline SP - 262 EP - 71 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 60 IS - 2 N2 - BACKGROUND: Cinacalcet effectively reduces elevated levels of parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (SHPT), even those with severe disease for whom parathyroidectomy can be the treatment of choice. The objective of this study was to estimate the cost-effectiveness of cinacalcet treatment in hemodialysis patients with severe SHPT in Japan. STUDY DESIGN: Cost-effectiveness analysis. SETTING & POPULATION: Patients with severe SHPT (intact PTH >500 pg/mL) who were receiving hemodialysis in Japan. MODEL, PERSPECTIVE, & TIMEFRAME: A Markov model was constructed from the health care system perspective in Japan. Patients were followed up over their lifetime. Dialysis costs were not included in the base case. INTERVENTION: Cinacalcet as an addition to conventional treatment compared to conventional treatment alone. In both arms, patients underwent parathyroidectomy if intact PTH level was >500 pg/mL for 6 months and they were eligible for surgery. OUTCOMES: Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: ICERs for cinacalcet for those who were eligible for surgery and those who were not were $352,631/QALY gained and $21,613/QALY gained, respectively. Sensitivity and scenario analyses showed that results were fairly robust to variations in model parameters and assumptions. In the probabilistic sensitivity analysis, cinacalcet was cost-effective in only 0.9% of simulations for those eligible for surgery, but in more than 99.9% of simulations for those ineligible for surgery, if society would be willing to pay $50,000 per additional QALY. LIMITATIONS: Data for the long-term effect of cinacalcet on patient-level outcomes are limited. The model predicted rates for clinical events using data for the surrogate biochemical end points. CONCLUSIONS: The use of cinacalcet to treat severe SHPT is likely to be cost-effective for only those who cannot undergo parathyroid surgery for medical or personal reasons. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/22445709/Cost_effectiveness_of_cinacalcet_hydrochloride_for_hemodialysis_patients_with_severe_secondary_hyperparathyroidism_in_Japan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(12)00462-3 DB - PRIME DP - Unbound Medicine ER -