title: Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan.
abstract: BACKGROUND
  Cinacalcet effectively reduces elevated levels of parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (SHPT), even those with severe disease for whom parathyroidectomy can be the treatment of choice. The objective of this study was to estimate the cost-effectiveness of cinacalcet treatment in hemodialysis patients with severe SHPT in Japan.
  
  
  METHODS
  Cost-effectiveness analysis.
  
  
  METHODS
  Patients with severe SHPT (intact PTH >500 pg/mL) who were receiving hemodialysis in Japan.
  
  
  METHODS
  A Markov model was constructed from the health care system perspective in Japan. Patients were followed up over their lifetime. Dialysis costs were not included in the base case.
  
  
  METHODS
  Cinacalcet as an addition to conventional treatment compared to conventional treatment alone. In both arms, patients underwent parathyroidectomy if intact PTH level was >500 pg/mL for 6 months and they were eligible for surgery.
  
  
  RESULTS
  Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  ICERs for cinacalcet for those who were eligible for surgery and those who were not were $352,631/QALY gained and $21,613/QALY gained, respectively. Sensitivity and scenario analyses showed that results were fairly robust to variations in model parameters and assumptions. In the probabilistic sensitivity analysis, cinacalcet was cost-effective in only 0.9% of simulations for those eligible for surgery, but in more than 99.9% of simulations for those ineligible for surgery, if society would be willing to pay $50,000 per additional QALY.
  
  
  CONCLUSIONS
  Data for the long-term effect of cinacalcet on patient-level outcomes are limited. The model predicted rates for clinical events using data for the surrogate biochemical end points.
  
  
  CONCLUSIONS
  The use of cinacalcet to treat severe SHPT is likely to be cost-effective for only those who cannot undergo parathyroid surgery for medical or personal reasons.
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Komaba
authors.forename: Kensuke
authors.initials: K
authors.lastname: Moriwaki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Goto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yamada
authors.forename: Masatomo
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kakuta
authors.forename: Isao
authors.initials: I
authors.lastname: Kamae
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000368:Aged; D000069449:Cinacalcet; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009281:Naphthalenes / Q000191:economics* / Q000627:therapeutic use*; D016105:Parathyroidectomy; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis
chemical_list: D009281:Naphthalenes; D000069449:Cinacalcet