TY - JOUR
T1 - Cost-effectiveness of cinacalcet hydrochloride for hemodialysis patients with severe secondary hyperparathyroidism in Japan
AU - Komaba, Hirotaka
AU - Moriwaki, Kensuke
AU - Goto, Shunsuke
AU - Yamada, Shunsuke
AU - Taniguchi, Masatomo
AU - Kakuta, Takatoshi
AU - Kamae, Isao
AU - Fukagawa, Masafumi
N1 - Funding Information:
Support: This work was funded by a research grant from the Japan Dialysis Outcome Research Group and a Grant-in-Aid for Young Scientists (B) ( 23790958 ) from the Ministry of Education, Culture, Sports, Science and Technology , Japan.
Funding Information:
Financial Disclosure: Drs Komaba, Taniguchi, and Kakuta have received honoraria from Kyowa Hakko Kirin, Chugai Pharmaceutical, and Bayer Yakuhin. Dr Kamae has received consulting fees from Bayer Schering Pharma AG. Dr Fukagawa has received honoraria and grant support from Kyowa Hakko Kirin , Chugai Pharmaceutical , and Bayer Yakuhin . The remaining authors declare that they have no relevant financial interests.
PY - 2012/8
Y1 - 2012/8
N2 - 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. Study Design: Cost-effectiveness analysis. Setting & Population: Patients with severe SHPT (intact PTH >500 pg/mL) who were receiving hemodialysis in Japan. Model, Perspective, & Timeframe: 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. Intervention: 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. Outcomes: 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. Limitations: 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.
AB - 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. Study Design: Cost-effectiveness analysis. Setting & Population: Patients with severe SHPT (intact PTH >500 pg/mL) who were receiving hemodialysis in Japan. Model, Perspective, & Timeframe: 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. Intervention: 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. Outcomes: 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. Limitations: 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.
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U2 - 10.1053/j.ajkd.2011.12.034
DO - 10.1053/j.ajkd.2011.12.034
M3 - Article
C2 - 22445709
AN - SCOPUS:84863990017
SN - 0272-6386
VL - 60
SP - 262
EP - 271
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -