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The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD.
J Med Econ. 2020 Mar; 23(3):308-315.JM

Abstract

Aims:

Patients with chronic kidney disease (CKD) not on dialysis frequently have vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT), which are associated with an increased risk of cardiovascular (CV) disease, fracture, CKD progression, and death. This study estimated the cost-effectiveness of extended-release calcifediol (ERC) vs paricalcitol for the treatment of patients with CKD stages 3-4 that have SHPT and VDI.Materials and methods: An economic analysis of SHPT treatments among a hypothetical cohort of 1,000 patients with CKD Stage 3 and 4 with SHPT and VDI was developed to estimate differences in the rates and costs of CV events, fractures, CKD stage progression, and mortality in patients treated with ERC and paricalcitol. A Markov model was developed with 1-year cycles and a 5-year time horizon from a US Medicare payer perspective with costs valued in 2017 US dollars.

Results:

The outcomes of the model were rates of clinical events, total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Across a 1,000-person cohort, ERC was the dominant (less costly, more effective) treatment strategy when compared with paricalcitol. Treatment with ERC resulted in cost savings of $14.8 M (95% CI = -$10.0 M-$45.2 M) and an incremental gain of 340 QALYs (95% CI = 200-496) compared to treatment with paricalcitol.Limitations: Bridging biochemical levels to clinical outcomes may not represent real-world risk of the clinical events modeled. Future real-world outcomes of patients treated with ERC and paricalcitol may be used to evaluate the model results.

Conclusions:

This model demonstrated favorable short- and long-term clinical benefits associated with the use of ERC in patients with CKD Stage 3 and 4 with SHPT and VDI, suggesting ERC may be cost-effective from the Medicare perspective compared to paricalcitol.

Authors+Show Affiliations

Division of Nephrology, University of California Irvine, School of Medicine, Orange, CA, USA.Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA.Health Economics and Outcomes Research, BluePath Solutions, Los Angeles, CA, USA.Renal Division, OPKO Health Inc., Miami, FL, USA.

Pub Type(s)

Clinical Trial, Phase III
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31726882

Citation

Kalantar-Zadeh, Kamyar, et al. "The Cost-effectiveness of Extended-release Calcifediol Versus Paricalcitol for the Treatment of Secondary Hyperparathyroidism in Stage 3-4 CKD." Journal of Medical Economics, vol. 23, no. 3, 2020, pp. 308-315.
Kalantar-Zadeh K, Hollenbeak CS, Arguello R, et al. The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD. J Med Econ. 2020;23(3):308-315.
Kalantar-Zadeh, K., Hollenbeak, C. S., Arguello, R., Snyder, S., & Ashfaq, A. (2020). The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD. Journal of Medical Economics, 23(3), 308-315. https://doi.org/10.1080/13696998.2019.1693385
Kalantar-Zadeh K, et al. The Cost-effectiveness of Extended-release Calcifediol Versus Paricalcitol for the Treatment of Secondary Hyperparathyroidism in Stage 3-4 CKD. J Med Econ. 2020;23(3):308-315. PubMed PMID: 31726882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cost-effectiveness of extended-release calcifediol versus paricalcitol for the treatment of secondary hyperparathyroidism in stage 3-4 CKD. AU - Kalantar-Zadeh,Kamyar, AU - Hollenbeak,Christopher S, AU - Arguello,Roy, AU - Snyder,Sophie, AU - Ashfaq,Akhtar, Y1 - 2019/12/09/ PY - 2019/11/16/pubmed PY - 2019/11/16/medline PY - 2019/11/16/entrez KW - 25-hydroxyvitamin D KW - C01 KW - C53 KW - C54 KW - I11 KW - chronic kidney disease KW - cost-effectiveness analysis KW - extended-release calcifediol KW - parathyroid hormone KW - secondary hyperparathyroidism KW - vitamin D insufficiency SP - 308 EP - 315 JF - Journal of medical economics JO - J Med Econ VL - 23 IS - 3 N2 - Aims: Patients with chronic kidney disease (CKD) not on dialysis frequently have vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT), which are associated with an increased risk of cardiovascular (CV) disease, fracture, CKD progression, and death. This study estimated the cost-effectiveness of extended-release calcifediol (ERC) vs paricalcitol for the treatment of patients with CKD stages 3-4 that have SHPT and VDI.Materials and methods: An economic analysis of SHPT treatments among a hypothetical cohort of 1,000 patients with CKD Stage 3 and 4 with SHPT and VDI was developed to estimate differences in the rates and costs of CV events, fractures, CKD stage progression, and mortality in patients treated with ERC and paricalcitol. A Markov model was developed with 1-year cycles and a 5-year time horizon from a US Medicare payer perspective with costs valued in 2017 US dollars.Results: The outcomes of the model were rates of clinical events, total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Across a 1,000-person cohort, ERC was the dominant (less costly, more effective) treatment strategy when compared with paricalcitol. Treatment with ERC resulted in cost savings of $14.8 M (95% CI = -$10.0 M-$45.2 M) and an incremental gain of 340 QALYs (95% CI = 200-496) compared to treatment with paricalcitol.Limitations: Bridging biochemical levels to clinical outcomes may not represent real-world risk of the clinical events modeled. Future real-world outcomes of patients treated with ERC and paricalcitol may be used to evaluate the model results.Conclusions: This model demonstrated favorable short- and long-term clinical benefits associated with the use of ERC in patients with CKD Stage 3 and 4 with SHPT and VDI, suggesting ERC may be cost-effective from the Medicare perspective compared to paricalcitol. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/31726882/The_cost_effectiveness_of_extended_release_calcifediol_versus_paricalcitol_for_the_treatment_of_secondary_hyperparathyroidism_in_stage_3_4_CKD_ L2 - https://www.tandfonline.com/doi/full/10.1080/13696998.2019.1693385 DB - PRIME DP - Unbound Medicine ER -