Pharmacological control of secondary hyperparathyroidism in hemodialysis subjects: a cost consequences analysis of data from the FARO study.
OBJECTIVE
Secondary hyperparathyroidism (SHPT) is a frequent complication of CKD with incidence, prevalence, and costs increasing worldwide. The objective of this analysis was to estimate therapy cost of SHPT in a sub-population of the FARO study.


METHODS
In the FARO study, an observational survey aimed to evaluate patterns of treatment in patients with SHPT who had undergone hemodialysis, pharmacological treatments and biochemical parameters evolution data were collected in four surveys. Patients maintaining the same treatment in all sessions were grouped by type of treatment and evaluated for costs from the Italian National Health Service perspective.


RESULTS
Four cohorts were identified: patients treated with oral (PO) calcitriol (n=182), intravenous (IV) calcitriol (n=34), IV paricalcitol (n=62), and IV paricalcitol+cinacalcet therapy (n=20); the cinacalcet monotherapy group was not analysed due to low number of patients (n=9). Parathyroid hormone (PTH) level at baseline and effectiveness of treatments in suppressing PTH level were assessed to test comparability among cohorts: calcitriol PO patients were significantly less severe than others (PTH level at baseline lower than 300 pg/ml; p<0.0001); calcitriol IV patients did not reach significant reduction in PTH level. Paricalcitol and paricalcitol+cinacalcet treatment groups results were comparable, while only the IV paricalcitol cohort's PTH level, weekly dosage, and cost decreased significantly from the first to the fourth survey (p=0.020, p=0.012, and p=0.0124, respectively). Total costs per week of treatment (including calcium-based phosphate binder and sevelamer) were significantly lower in the paricalcitol vs paricalcitol+cinacalcet cohort (p<0.001). Major limitations of this study are related to the survey design: not controlled and lack of comparability between cohorts; however, reflective of true practice patterns.


CONCLUSIONS
The IV Paricalcitol cohort had significantly lower treatment costs compared with patients treated with paricalcitol+calcimemtics (p<0.001), without a significant difference in terms of baseline severity and PTH control.
daniela_roggeri@procuresolutions.it
Daniela Paola
DP
Roggeri
Sandro
S
Mazzaferro
Diego
D
Brancaccio
Giuseppe
G
Cannella
Piergiorgio
P
Messa
Marina
M
Di Luca
Massimo
M
Morosetti
Anna Maria
AM
Costanzo
Umberto
U
di Luzio Paparatti
Dante
D
Cornago
Mario
M
Cozzolino
D000368:Aged; D000369:Aged, 80 and over; D002117:Calcitriol / Q000191:economics* / Q000627:therapeutic use; D000069449:Cinacalcet; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004872:Ergocalciferols / Q000191:economics* / Q000627:therapeutic use; D005252:Fees, Pharmaceutical; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000191:economics* / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications
D004872:Ergocalciferols; D009281:Naphthalenes; D010281:Parathyroid Hormone; C084656:paricalcitol; D002117:Calcitriol; D000069449:Cinacalcet