title: Cost per responder analysis in patients with secondary hyperparathyroidism on dialysis treated with cinacalcet.
abstract: BACKGROUND
  Growing financial pressure on US dialysis providers requires economic efficiency considerations. The objective of this study was to examine short-term economic efficiencies of a cinacalcet-based treatment approach for secondary hyperparathyroidism.
  
  
  METHODS
  This study retrospectively assessed cost per biochemical response of the OPTIMA trial. OPTIMA was conducted in end-stage renal disease patients to compare biochemical control in patients receiving cinacalcet in addition to vitamin D sterols and phosphate binders vs patients receiving vitamin D sterol and phosphate binders alone. It explored three laboratory measurement response definitions from baseline to week 23: (1) decreases in parathyroid hormone (PTH) ≥30%; (2) PTH ≤ 300 pg/ml; and (3) PTH ≤ 300 pg/mL, calcium <9.5 mg/dL and phosphorus <5.5 mg/dL. Medication use and costs were measured to calculate average costs and incremental cost per responder. Stratification by lower and higher baseline PTH assessed cost per response by disease severity.
  
  
  RESULTS
  There were 38-77% more responders with cinacalcet vs control, depending on response definition. Mean (SD) per patient total medication costs were $5423 ($3698) for cinacalcet and $2633 ($2334) for control, leading to a mean difference of $2790 over 23 weeks. When response was defined as a decrease in PTH ≥ 30% from baseline, the average cost per responder was $11,266 for control vs $7027 for cinacalcet. The incremental cost per incremental responder ranged from $5186-$9168. Across all response measures, cost per responder was lower in patients with lower baseline PTH.
  
  
  CONCLUSIONS
  Representing a more efficient allocation of economic resources over the short-term, cinacalcet-based treatment algorithm led to a lower cost per biochemical response, particularly in patients with lower disease severity, vs vitamin D sterols and phosphate binders alone. These findings should be interpreted alongside the study limitation of converting international trial-based medication utilization into US costs.
authors.affiliation: Amgen Inc., Thousand Oaks, CA 91320, USA. vasilyb@amgen.com
authors.forename: Vasily
authors.initials: V
authors.lastname: Belozeroff
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
authors.forename: Spring
authors.initials: S
authors.lastname: Tseng
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiroli
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000465:Algorithms; D000069449:Cinacalcet; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000191:economics* / Q000627:therapeutic use; D006435:Renal Dialysis / Q000191:economics / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014807:Vitamin D / Q000191:economics* / Q000627:therapeutic use
chemical_list: D009281:Naphthalenes; D014807:Vitamin D; D000069449:Cinacalcet