Analisi costo-efficacia di cinacalcet più terapia standard versus terapia standard nel trattamento dei pazienti in dialisi con iperparatiroidismo secondario

Summary

Objectives: The aim of this study was to assess the incremental cost-effectiveness ratio of cinacalcet versus conventional care in the treatment of secondary hyperparathyroidism (SHPT) on chronic haemodialysis patients.

Methods: An observational study was conducted in the Nephrology and Dialysis Centre of “Ospedale Cardinal Massaja” in Asti. Data were collected with reference to 17 patients who had secondary hyperparathyroidism on chronic haemodialysis and were referred consecutively to the Centre between October 2005 and June 2006. At the recruitment, the patients had a poorly controlled SHPT (PHT > 300 pg/dl) and received a conventional care. The analysis was performed considering two different periods: the retrospective period and the prospective period. The first period evaluated the effectiveness and the costs for 17 patients during the 6 months before the recruitment (conventional care). The second period considered the effectiveness and the costs for 17 patients during the 6 months after the recruitment (cinacalcet + conventional care). The study observed the 17 patients for 12 months in all. The primary endpoint was the proportion of patients who reached the therapeutic target assessed by K/DOQI Guidelines (PTH ≤ 300 pg/dl e Ca × P ≤ 55 mg²/dl²) during 6 months (retrospective phase and prospective phase). The economic evaluation considered only direct medical costs. Costs (2007 euros) and benefits were not discounted. Sensitivity analyses on key clinical and economic parameters were performed. The analysis was conducted from the perspective of the Italian National Health Service.

Results: A higher proportion of patients receiving the cinacalcet-based regimen vs conventional care achieved the targets for K/DOQI Guidelines (52,9% vs 0%). Treatment with cinacalcet plus conventional care (€ 3,733.67) turned out to be more costly versus conventional care (€ 2,834.01). We calculated for cinacalcet plus conventional care versus conventional care the incremental cost per patient who reached the therapeutic target. It was € 1,700.68 (male: € 1,268.77 and female: € 2,236.33).

Conclusion: This economic evaluation suggests that in patients for whom conventional therapy was no longer effective, cinacalcet plus conventional care increased achievement of K/DOQI Guidelines treatment targets, at acceptable costs by the standards of the Italian NHS.