Clinical Drug Investigation

, Volume 26, Issue 11, pp 629–638 | Cite as

Health-Economic Comparison of Paricalcitol, Calcitriol and Alfacalcidol for the Treatment of Secondary Hyperparathyroidism during Haemodialysis

  • Hubertus Rosery
  • Rito Bergemann
  • Steven E. Marx
  • Axel Boehnke
  • Joel Melnick
  • Raimund Sterz
  • Laura Williams
Review Article


This study evaluated the health-economic consequences of use of intravenous paricalcitol (Zemplar®), oral calcitriol or oral and intravenous alfacalcidol for the treatment of patients with secondary hyperparathyroidism, focusing on a third-party payer perspective through inclusion of medication and hospital costs, survival rates and utilities. Cost values were based on German treatment recommendations and prices. Reference values for survival rates and utilities were based on the results of a MEDLINE search. The analysis showed a clear advantage for intravenous paricalcitol with respect to costs, effectiveness and utilities compared with treatment with oral calcitriol or intravenous alfacalcidol. Since the results were very cost sensitive with respect to selected diagnosis-related groups (DRGs) for kidney disease with dialysis, a sensitivity analysis was performed. This demonstrated first-order dominance of intravenous paricalcitol for a wide range of hospitalisation costs. In conclusion, this analysis suggested a clear benefit from the perspective of a third-party payer for intravenous paricalcitol compared with oral calcitriol and intravenous alfacalcidol in the treatment of patients with secondary hyperparathyroidism.


Chronic Kidney Disease Haemodialysis Patient Utility Score Secondary Hyperparathyroidism Define Daily Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Compilation of this review was funded by Abbott prior to completion of the review, and funding was thus independent of the research results. Drs Marx, Melnick, Sterz and Williams and Mr Boehnke are employees of Abbott. Drs Rosery and Bergemann have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Cohen EP, Moulder JE. Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron 2002; 89: 271–3CrossRefGoogle Scholar
  2. 2.
    Salem MM. Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis 1997; 29(6): 862–5PubMedCrossRefGoogle Scholar
  3. 3.
    United States Renal Data System. Cardiovascular report [online]. Available from URL: [Accessed 2006 Aug 2]
  4. 4.
    National Kidney Foundation, Inc. K/DOQI Clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Guideline 8: vitamin D therapy in chronic kidney disease patients. Guideline 8b: vitamin D therapy in patients on dialysis (chronic kidney disease stage 5) [online]. Available from URL: and [Accessed 2006 Aug 2]
  5. 5.
    Díaz-Corte C, Naves Diaz ML, Gomez Alonso C, et al. Prevention, diagnosis and treatment of renal osteodystrophy in Spain: preliminary results from a multicentre enquiry. Nephrol Dial Transplant 1998; 13Suppl. 3: 51–6PubMedCrossRefGoogle Scholar
  6. 6.
    Gallieni M, Cucciniello E, D’Amaro E Fatuzzo P, et al. Calcium, phosphate, and PTH levels in the hemodialysis population: a multicenter study. J Nephrol 2002; 15: 165–70PubMedGoogle Scholar
  7. 7.
    Frei U, Schober-Halstenberg H-J. Renal replacement therapy in Germany: report on dialysis and renal transplantation 2003/ 2004. QuaSi-Niere gGmbH (non-profit ltd) [online]. Available from URL: [Accessed 2006 Sep 20]
  8. 8.
    Coco M, Rush H. Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 2002; 36: 1115–21CrossRefGoogle Scholar
  9. 9.
    Schomig M, Ritz E. Management of disturbed calcium metabolism in uraemic patients: 1. Use of vitamin D metabolites. Nephrol Dial Transplant 2000; 15Suppl. 5: 18–24PubMedCrossRefGoogle Scholar
  10. 10.
    Silver J, Russell J, Sherwood LM. Regulation by vitamin D metabolites of messenger RNA for preparathyroid hormone in isolated bovine parathyroid cells. Proc Natl Acad Sci U S A 1985; 82: 4270–3PubMedCrossRefGoogle Scholar
  11. 11.
    Ramirez JA, Emmett M, White MG, et al. The absorption of dietary phosphorus and calcium in hemodialysis patients. Kidney Int 1986; 30: 753–9PubMedCrossRefGoogle Scholar
  12. 12.
    Block GA, Port FK. Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 2000; 35: 1226–35PubMedCrossRefGoogle Scholar
  13. 13.
    Salusky IB, Goodman WG. Cardiovascular calcification in end stage renal disease. Nephrol Dial Transplant 2002; 17: 336–9PubMedCrossRefGoogle Scholar
  14. 14.
    Tsuchihashi K, Takizawa H, Torii T, et al. Hypoparathyroidism potentiates cardiovascular complications through disturbed calcium metabolism: possible risk of vitamin D(3) analog administration in dialysis patients with end-stage renal disease. Nephron 2000; 84: 13–20PubMedCrossRefGoogle Scholar
  15. 15.
    Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: S112–9PubMedCrossRefGoogle Scholar
  16. 16.
    Brown AJ, Finch J, Slatopolsky E. Differential effects of 19-nor-1,25-dihydroxyvitamin D(2) and 1,25-dihydroxy-vitamin D(3) on intestinal calcium and phosphate transport. J Lab Clin Med 2002; 139: 279–84PubMedCrossRefGoogle Scholar
  17. 17.
    Finch JL, Brown AJ, Slatopolsky E. Differential effects of 1,25-dihydroxy-vitamin D3 and 19-nor-1,25-dihydroxy-vitamin D2 on calcium and phosphorus resorption in bone. J Am Soc Nephrol 1999; 10: 980–5PubMedGoogle Scholar
  18. 18.
    Goldenberg MM. Paricalcitol, a new agent for the management of secondary hyperparathyroidism in patients undergoing chronic renal dialysis. Clin Ther 1999; 21(3): 432–41PubMedCrossRefGoogle Scholar
  19. 19.
    Lindberg J, Martin KJ, Gonzalez EA, et al. A long-term, multicenter study of the efficacy and safety of paricalcitol in end-stage renal disease. Clin Nephrol 2001; 56: 315–23PubMedGoogle Scholar
  20. 20.
    Martin K, Gonzalez EA, Gellens ME, et al. 19-nor-1-alpha-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 1998; 9: 1427–32PubMedGoogle Scholar
  21. 21.
    Teng M, Wolf M, Ofsthun MN, et al. Activated injectable vitamin D and hemodialysis survival: a historical cohort study. J Am Soc Nephrol 2005; 16(4): 1115–25PubMedCrossRefGoogle Scholar
  22. 22.
    Dobrez DG, Mathes A, Amdahl M, et al. Paricalcitol-treated patients experience improved hospitalization outcomes compared with calcitriol-treated patients in real-world clinical settings. Nephrol Dial Transplant 2004; 19: 1168–73CrossRefGoogle Scholar
  23. 23.
    Teng M, Wolf M, Lowrie E, et al. Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 2003; 349: 446–56PubMedCrossRefGoogle Scholar
  24. 24.
    Sprague SM, Llach F, Amdahl M, et al. Paricalcitol versus calcitriol in the treatment of secondary hyperparathyroidism. Kidney Int 2003; 63: 1483–903PubMedCrossRefGoogle Scholar
  25. 25.
    Rote Liste® Service GmbH (2005) Arzneimittelliste Deutschland January 2005 [online]. Available from URL: [Accessed 2005 May 11]
  26. 26.
    Documed AG, Basel (2006) Arzneimittel-Kompendium der Schweiz®. Kompendium 1. Basel (Switzerland): 2006 [online]. Available from URL: [Accessed 2006 Aug 2]
  27. 27.
    Marx SM, Brown LM, Ashraf T, et al. Evaluation of annualized dosing ratio of paricalcitol to calcitriol in hemodialysis patients [abstract]. J Am Soc Nephrol 2004; 15: 862AGoogle Scholar
  28. 28.
    Medizinische Medien Informations GmbH (2005) Gelbe Liste Pharmindex [online]. Available from URL: = 1 [Accessed 2005 May 6]
  29. 29.
    ICD-10. International Code of Diseases [online]. Available from URL: [Accessed 2006 Aug 02]
  30. 30.
    Wolf M, Teng M, Thadhani R. Paricalcitol, calcitriol and survival of patients undergoing hemodialysis. N Engl J Med 2003; 349: 1771–2Google Scholar
  31. 31.
    Harvard Center for Risk Analysis. The cost effectiveness analysis (CEA) registry: catalogue of preference scores 1998–2001 [online]. Available from URL: and [Accessed 2006 Aug 2]
  32. 32.
    Lawrence WF, Grist TM, Brazy PC. Magnetic resonance angiography in progressive renal failure: a technology assessment. Am J Kidney Dis 1995; 25(5): 701–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Eastman RC, Javitt JC, Herman WH. Model of complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20(5): 735–44PubMedCrossRefGoogle Scholar
  34. 34.
    Kiberd BA, Jindal KK. Screening to prevent renal failure in insulin dependent diabetic patients: an economic evaluation. BMJ 1995; 311: 1595–9PubMedCrossRefGoogle Scholar
  35. 35.
    Diabetes Control and Complications Trial Research Group. Lifetime benefits and costs of intensive therapy as practiced in the Diabetes Control and Complications Trial. JAMA 1996; 276: 1409–15CrossRefGoogle Scholar
  36. 36.
    van Os N, Messen LW, Bilo HJ, et al. Diabetes nephropathy in The Netherlands: a cost effectiveness analysis of national clinical guidelines. Health Policy 2000; 51(3): 135–47PubMedCrossRefGoogle Scholar
  37. 37.
    Kiberd BA, Jindal KK. Routine treatment of insulin-dependent diabetic patients with ACE inhibitors to prevent renal failure: an economic evaluation. Am J Kidney Dis 1998; 31(1): 49–54PubMedCrossRefGoogle Scholar
  38. 38.
    de Wit GA, Ramsteijn PG, de Charro FT. Economic evaluation of end stage renal disease treatment. Health Policy 1998; 44(3): 215–32PubMedCrossRefGoogle Scholar
  39. 39.
    Kiberd BA. Should hepatitis C-infected kidneys be transplanted in the United States? Transplantation 1994; 57(7): 1068–72PubMedGoogle Scholar
  40. 40.
    Churchill DN, Rorrance GW, Taylor DW, et al. Measurement of quality of life in end-stage renal disease: the time trade-off approach. Clin Invest Med 1987 Jan; 10(1): 14–20PubMedGoogle Scholar
  41. 41.
    Coffey JT, Brandie M, Zhou H, et al. Valuing health-related quality of life in diabetes. Diabetes Care 2002 Dec; 25(12): 2238–43PubMedCrossRefGoogle Scholar
  42. 42.
    Capomolla S, Febo O, Ceresa M, et al. Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care. J Am Coll Cardiol 2002; 40: 1259–66PubMedCrossRefGoogle Scholar
  43. 43.
    Glick HA, Orzol SM, Tooley JF, et al. Economic evaluation of the Randomized Aldactone Evaluation Study (RALES): treatment of patients with severe heart failure. Cardiovasc Drugs Ther 2002; 16(1): 53–9PubMedCrossRefGoogle Scholar
  44. 44.
    Schwabe S, Paffrath D. Arzneiverordnungsreport 2004. Aktuelle Daten, Kosten, Trends und Kommentare. Berlin: Springer-Verlag, 2004Google Scholar
  45. 45.
    United States Renal Data System. Annual data report. Chapter 6: morbidity & mortality; page 4 of 24 [online]. Available from URL: [Accessed 2006 Aug 2]
  46. 46.
    OECD Health Data 2005 Oct 5 [online]. Available from URL:,2340,en_2649_34631_2085214_1_1_1_1,00.html [Accessed 2006 Apr 14]
  47. 47.
    Tentori F, Hunt WC, Stidley CA, et al. Survival among hemodialysis patients receiving intravenous doxercalciferol and paricalcitol versus calcitriol. TH-PO737. Philadelphia (PA): American Society of Nephrology, 2005: 8–13Google Scholar
  48. 48.
    Young EW, Albert JM, Akiba T, et al. Vitamin D therapy and mortality in the dialysis outcomes and practice patterns Study (DOPPS). Philadelphia (PA): American Society of Nephrology, 2005: 8–13Google Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Hubertus Rosery
    • 1
  • Rito Bergemann
    • 1
  • Steven E. Marx
    • 2
  • Axel Boehnke
    • 3
  • Joel Melnick
    • 2
  • Raimund Sterz
    • 3
  • Laura Williams
    • 2
  1. 1.Analytica International GmbH, German OfficeLoerrachGermany
  2. 2.Abbott LaboratoriesChicagoUSA
  3. 3.Abbott GmbH & Co. KGLudwigshafenGermany

Personalised recommendations