Impact of secondary hyperparathyroidism on disease progression, healthcare resource utilization and costs in pre-dialysis CKD patients

ABSTRACT

Background and objectives: Secondary hyperparathyroidism (SHPT) can lead to significant morbidity, mortality, and additional healthcare resource utilization in chronic kidney disease (CKD) stage 5. The objective of this study was to examine healthcare costs and utilization, and the risks of dialysis or mortality, among pre-dialysis CKD patients with and without SHPT.

Research design and methods: This retrospective cohort study examined insurance claims from 66 644 adult, pre-dialysis, CKD patients with and without SHPT during a 72-month period. Annualized estimates of healthcare costs and utilization, and disease progression to dialysis or death following index CKD diagnosis were compared.

Results: Post-index annualized costs and inpatient healthcare resource utilization was higher in those with SHPT in both unadjusted and adjusted (controlling for gender, age, plan type, payer type, geographic region, physician specialty, pre-index co-morbidities, and pre-index total healthcare costs), and unmatched and matched analyses. Kaplan–Meier analysis demonstrated that the rate of progression to dialysis or death was higher for CKD with SHPT compared to CKD without SHPT, and Cox proportional hazard models suggested that CKD patients with SHPT were more than four to five times as likely to initiate dialysis or die as compared to CKD without SHPT.

Conclusion: SHPT in pre-dialysis CKD patients is associated with significantly greater healthcare costs, inpatient hospitalizations, and a faster rate of disease progression compared to pre-dialysis CKD without SHPT. Since observational studies are designed to demonstrate associations rather than causality, further investigation is required to confirm these findings.

Key words: :

• Chronic kidney disease
• Costs
• Hyperparathyroidism
• Utilization

Acknowledgements

Declaration of interest: D.A., S.E.M. and R.S. are employees of Abbott, the manufacturer of calcitriol and paricalcitol, both of which are vitamin D receptor activators. G.T.S. and K.K.-Z. have served as paid consultants to Abbott. A.T.J. is an employee of PharMetrics Inc. (a unit of IMS, Watertown, MA, USA), which was paid by Abbott to conduct the analyses presented in this article. No editorial assistance was provided during the preparation of this manuscript.

Notes

* Portions of this study were presented in abstract form at the American Society of Nephrology, Renal Week, San Diego, CA, USA, November 2006; the International Society of Nephrology Meeting, Barcelona, Spain, October 2006; World Congress of Nephrology, Rio de Janerio, Brazil, April 2007; and the International Society for Pharmacoeconomics & Outcomes Research annual meeting, Arlington, VA, USA, May 2007