Cinacalcet - clinical and laboratory effectiveness, concomitant treatment patterns and treatment cost: could we do better and how?
BACKGROUND
The cost and effectiveness patterns in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients in the Czech Republic are unknown.


METHODS
52 dialysis patients from 17 centers were followed up in a multicenter prospective study of laboratory and clinical (hospitalization rate, clinical complaints questionnaire) responses to 12-month cinacalcet treatment. Treatment patterns and cost (including phosphate binders, vitamin D, and cinacalcet) were evaluated.


RESULTS
The mean s-Ca dropped significantly from 2.36 ± 0.24 to 2.21 ± 0.20 mmol/l, s-P from 2.45 ± 0.54 to 2.01 ± 0.53 mmol/l, Ca×P from 5.79 ± 1.25 to 4.42 ± 1.13 mmol²/l², and iPTH dropped from 919.0 ± 465.6 to 372.1 ± 294.6 pg/ml. The mean cinacalcet dose reached 44.1 ± 23.0 mg/day after 12 months. Itching intensity decreased significantly. No change in hospitalization rate was observed. The direct cost of daily SHPT treatment rose significantly from EUR 8.77 ± 9.59 to 20.62 ± 9.22.


CONCLUSIONS
Cinacalcet decreased elevated s-Ca, s-P, Ca×P, and iPTH, alleviated itching, and significantly raised the SHPT treatment cost. A minority of patients reached K/DOQI targets, especially due to poor phosphate control caused by insufficient phosphate binder treatment, cinacalcet underdosing, and advanced SHPT.
Smržová
Jana
J
Dialysis and Nephrology Center, University Hospital, Brno, Czech Republic. jsmrzova@gmail.com
Urbánek
Tomáš
T
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D000069449:Cinacalcet; D018153:Czech Republic; D004341:Drug Evaluation; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000191:economics / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D009281:Naphthalenes; D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium; D000069449:Cinacalcet