An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism--the German perspective.
BACKGROUND
Treatment options for secondary hyperparathyroidism were significantly amended with the introduction of cinacalcet and paricalcitol. Limitations of resources in public health systems demand detailed analyses of accruing costs. The aim of this study was to compare the costs of these new treatment modalities to surgery.


METHODS
Patients who underwent initial parathyroidectomy (n = 91) and patients treated with cinacalcet or paricalcitol (n = 100) at an ambulatory dialysis center between 01/2003 and 12/2006 were analyzed. The revenues of both therapies for the funding agencies were calculated by a cost-cost analysis. The real arising costs of the supplier were analyzed and compared to the revenues.


RESULTS
Treatment costs for cinacalcet (60 mg/day/year) were 5828.40€ and 4485.20€ for paricalcitol (15 μg/week/year). Revenues for inpatient surgical treatment according to the German DRG system were 3755.38€/case. Additionally, costs for postoperative ambulatory therapies were 545.05€ for the first year and 384.97€ for the following.


CONCLUSIONS
Due to linearly increases, expenses of medical treatment with cinacalcet for more than 9 months or paricalcitol for more than 12 months exceeded the costs of surgical therapy. The indication of these new medical therapies should be restricted to patients as an interim solution ahead of surgery or in patients considered unfit for surgery.
Department of Visceral, Thoracic and Vascular Surgery, Philipps University, Marburg, Germany. Ralph.Schneider@med.uni-marburg.de
Ralph
R
Schneider
Georgios
G
Kolios
Benjamin M
BM
Koch
Emilio Domínguez
ED
Fernández
Detlef K
DK
Bartsch
Katja
K
Schlosser
D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D000069449:Cinacalcet; D003363:Cost Control / Q000379:methods; D003365:Costs and Cost Analysis / Q000379:methods; D004872:Ergocalciferols / Q000191:economics / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D009281:Naphthalenes / Q000191:economics / Q000627:therapeutic use; D016105:Parathyroidectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data
D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D009281:Naphthalenes; C084656:paricalcitol; D000069449:Cinacalcet