Health economic evaluation of paricalcitol(®) versus cinacalcet + calcitriol (oral) in Italy. [corrected].
OBJECTIVE
Chronic kidney disease (CKD) is a highly morbid disorder. The most severe form of CKD is end-stage renal disease (ESRD), in which the patient requires some form of renal replacement therapy to survive. The increasing incidence, prevalence, and costs of ESRD are major national healthcare concerns. The objective of this study was to determine the cost effectiveness of two innovative therapies, paricalcitol versus cinacalcet + calcitriol (oral) in patients with CKD stage 5 (CKD 5) in the healthcare setting in Italy in 2013.


METHODS
A Markov process model was developed employing data sources from the published literature, paricalcitol clinical trials, official Italian price/tariff lists, and national population statistics. The analysis is based on a comparison of treatment with paricalcitol versus cinacalcet + calcitriol (oral) in CKD 5. The perspective of the study was that of the payer [Italian National Health Service (INHS)]. The primary efficacy outcomes in the paricalcitol and cinacalcet + calcitriol (oral) clinical trials (reduction of secondary hyperparathyroidism, complications, and mortality) were extrapolated to effectiveness outcomes: number of life-years gained (LYG) and number of quality-adjusted life-years (QALYs). Clinical and economic outcomes were discounted at 3 %.


RESULTS
The base-case analysis is based on a 5-year time horizon. From the INHS perspective, the use of paricalcitol leads to a cost saving of €1,853 and an increase in LYG (0.136) and a gain in QALYs (0.089). Consequently, the use of paricalcitol is dominant over the use of combination cinacalcet + calcitriol (oral paricalcitol leads to cost savings and a higher effectiveness). Sensitivity analyses confirmed the robustness of the model.


CONCLUSIONS
The results showed that the favorable clinical benefit of paricalcitol results in positive health economic benefits. This study suggests that the use of paricalcitol in patients with ESRD may be cost effective from the perspective of the INHS.
Ars Accessus Medica, Amsterdam, The Netherlands, marknuijten@arsaccessusmedica.com.
Mark
M
Nuijten
Daniela P
DP
Roggeri
Alessandro
A
Roggeri
Paolo
P
Novelli
Thomas S
TS
Marshall
D002117:Calcitriol / Q000008:administration & dosage / Q000191:economics*; D000069449:Cinacalcet / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D004872:Ergocalciferols / Q000191:economics*; D006801:Humans; D007558:Italy; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years
D004872:Ergocalciferols; C084656:paricalcitol; D002117:Calcitriol; D000069449:Cinacalcet