Cost-Effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients With Severe Secondary Hyperparathyroidism in Japan
Cost-Effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients With Severe Secondary Hyperparathyroidism in Japan
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DOI：
10.1053/j.ajkd.2011.12.034
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发表时间：
2012-08-01
影响因子：
13.2
通讯作者：
Fukagawa, Masafumi
中科院分区：
文献类型：
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作者：
Komaba, Hirotaka;Moriwaki, Kensuke;Fukagawa, Masafumi
背景资料：西那卡塞可有效降低继发性甲状旁腺功能亢进（SHPT）患者的甲状旁腺激素（PTH）水平升高，即使是甲状旁腺切除术可作为治疗选择的严重疾病患者。本研究的目的是评估西那卡塞治疗日本重度SHPT血液透析患者的成本效益。研究设计：成本效益分析。设置和人群：在日本接受血液透析的重度SHPT（全段甲状旁腺素>500 pg/mL）患者。模型、视角和时间范围：从日本医疗保健系统的角度构建马尔可夫模型。患者在其一生中接受随访。基础病例中不包括透析费用。干预：西那卡塞作为常规治疗的补充与单独常规治疗相比。在两组中，如果患者的PTH水平>500 pg/mL，持续6个月，则接受甲状旁腺切除术，并且符合手术条件。结果：成本、质量调整生命年（QERS）和增量成本效益比（ICER）。符合手术条件的患者和不符合手术条件的患者的西那卡塞ICER分别增加了352，631美元/QALY和21，613美元/QALY。敏感性和情景分析表明，结果对模型参数和假设的变化相当稳健。在概率敏感性分析中，西那卡塞在符合手术条件的模拟中仅占0.9%，但在不符合手术条件的模拟中占99.9%以上，如果社会愿意为每个额外的QALY.Limitations支付50，000美元：西那卡塞对患者水平结局的长期影响的数据有限。该模型预测率的临床事件使用数据的替代生化endpoints.Conclusions：使用西那卡塞治疗严重SHPT可能是具有成本效益的，只有那些谁不能接受甲状旁腺手术的医疗或个人原因。美国肾脏病杂志60（2）：262-271。(C)2012年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
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. Am J Kidney Dis. 60(2):262-271. (C) 2012 by the National Kidney Foundation, Inc.