Original InvestigationDialysisCost-Effectiveness of Cinacalcet Hydrochloride for Hemodialysis Patients With Severe Secondary Hyperparathyroidism in Japan
Section snippets
Study Design
We constructed a Markov model to estimate quality-adjusted life-years (QALYs) and lifetime costs associated with cinacalcet plus conventional treatment compared with conventional treatment alone for the treatment of severe SHPT. Because no randomized trials have evaluated whether treatment of SHPT with cinacalcet reduces the risk of mortality and CV morbidity, we modeled the effect of cinacalcet on patient-level outcomes using data from observational studies on the risk of clinical events in
Clinical Outcomes
Patient-level outcomes in the economic model for 1,000 patients are listed in Table 5. For patients who are eligible for parathyroidectomy, the addition of cinacalcet to conventional treatment resulted in a marked decrease in the incidence of parathyroidectomy, but there were only slight differences in the incidences of CV events, fracture, and mortality between the arms of the model. In contrast, use of cinacalcet for those ineligible for parathyroidectomy was predicted to result in decreased
Discussion
Many clinical trials have shown that cinacalcet effectively controls biochemical parameters of SHPT.20, 21, 22, 23, 24, 25 However, just a few studies to date have estimated the cost-effectiveness of this agent. Narayan et al26 compared the cost-effectiveness of cinacalcet and parathyroidectomy in patients who were potential candidates for surgery in the United States and showed that long-term use of cinacalcet to treat severe SHPT is unlikely to be cost-effective compared with
Acknowledgements
The authors thank Kyowa Hakko Kirin for providing data for the clinical trials of KRN1493.
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.
Financial Disclosure: Drs Komaba, Taniguchi, and Kakuta have received honoraria from Kyowa Hakko Kirin, Chugai Pharmaceutical, and Bayer Yakuhin. Dr Kamae has received consulting
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Originally published online March 26, 2012.
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H.K. and K.M. contributed equally to this work.