title: A cost-utility analysis of cinacalcet in secondary hyperparathyroidism in five European countries.
abstract: OBJECTIVE
  A probabilistic patient-level Markov model was previously developed to simulate lifetime clinical and economic outcomes of cinacalcet treatment in secondary hyperparathyroidism (SHPT) patients using local data from Italy. The present study extends the application of the model to four other European countries - Spain, Portugal, Switzerland and the Czech Republic - in order to assess the consistency of results.
  
  
  METHODS
  Cinacalcet influences the levels of parathyroid hormone, serum calcium and phosphorous. Our simulation was based on data from the OPTIMA (Open-Label, Randomized Study Using Cinacalcet to Improve Achievement of KDOQI Targets in Patients with End-Stage Renal Disease) randomized controlled trial and from published correlations between bone-metabolism parameters, mortality and morbidity (cardiovascular [CV] events, fractures and parathyroidectomy). Local epidemiological and cost data for dialysis, drugs and event management were incorporated into the model. The simulation horizon was patient lifetime; standard treatment for SHPT (vitamin D sterols and phosphate binders) and cinacalcet plus standard treatment were compared. Effectiveness was measured in terms of life expectancy (LE) and quality-adjusted life expectancy (QALE). Health utility indexes derived from published literature took into account dialysis, CV events and fractures.
  
  
  RESULTS
  The simulated mean LE extension in patients receiving cinacalcet was 1.20 life-years (LY) in Italy, 1.10 LY in Spain, 1.18 LY in Portugal, 1.10 LY in the Czech Republic and 1.40 LY in Switzerland. QALE increase was 0.89, 0.82, 0.89, 0.80 and 1.01 QALY in the same countries, respectively. The incremental cost-effectiveness ratio (ICER) result was €23,500/LY and €31,600/QALY in Italy, €21,800/LY and €29,300/QALY in Spain, €23,700/LY and €31,200/QALY in Portugal, €29,700/LY and €40,800/QALY in the Czech Republic and €24,700/LY and €34,200/QALY in Switzerland. Including dialysis costs as a part of the total costing doubled the ICER, from a minimum of €42,800/LY in Spain to a maximum of €82,800/LY in Switzerland and in the range from €57,500/QALY (Spain) to €114,700/QALY (Switzerland).
  
  
  CONCLUSIONS
  Taking into consideration the limited clinical, epidemiological and health economics data available, cinacalcet treatment showed a relatively good cost-effectiveness profile in all the countries analysed, despite the differences in their healthcare systems and economic wealth.
authors.affiliation: IMS Consulting Group, Milan, Italy. siannazzo@imscg.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Iannazzo
authors.forename: Michela
authors.initials: M
authors.lastname: Carsi
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiroli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057966:Calcimimetic Agents / Q000191:economics* / Q000627:therapeutic use; D000069449:Cinacalcet; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009281:Naphthalenes / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D055815:Young Adult
chemical_list: D057966:Calcimimetic Agents; D009281:Naphthalenes; D000069449:Cinacalcet