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.
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).


CONCLUSIONS
Unless the cost of cinacalcet is considerably reduced, it is unlikely to be considered a cost-effective treatment for people with SHPT.
Garside
Ruth
R
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.uk
Pitt
Martin
M
Anderson
Rob
R
Mealing
Stuart
S
D'Souza
Richard
R
Stein
Ken
K
D000069449:Cinacalcet; D003362:Cost-Benefit Analysis; D004035:Diet Therapy / Q000191:economics / Q000379:methods; D016527:Drug Costs; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008390:Markov Chains; D008875:Middle Aged; D009281:Naphthalenes / Q000191:economics* / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000378:metabolism; D028044:Phosphate-Binding Proteins / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D006113:United Kingdom; D014807:Vitamin D / Q000191:economics / Q000627:therapeutic use
D009281:Naphthalenes; D010281:Parathyroid Hormone; D028044:Phosphate-Binding Proteins; D014807:Vitamin D; D000069449:Cinacalcet