Cost per responder analysis in patients with secondary hyperparathyroidism on dialysis treated with cinacalcet

Abstract

Background:

Growing financial pressure on US dialysis providers requires economic efficiency considerations. The objective of this study was to examine short-term economic efficiencies of a cinacalcet-based treatment approach for secondary hyperparathyroidism.

Methods:

This study retrospectively assessed cost per biochemical response of the OPTIMA trial. OPTIMA was conducted in end-stage renal disease patients to compare biochemical control in patients receiving cinacalcet in addition to vitamin D sterols and phosphate binders vs patients receiving vitamin D sterol and phosphate binders alone. It explored three laboratory measurement response definitions from baseline to week 23: (1) decreases in parathyroid hormone (PTH) ≥30%; (2) PTH ≤ 300 pg/ml; and (3) PTH ≤ 300 pg/mL, calcium <9.5 mg/dL and phosphorus <5.5 mg/dL. Medication use and costs were measured to calculate average costs and incremental cost per responder. Stratification by lower and higher baseline PTH assessed cost per response by disease severity.

Results:

There were 38–77% more responders with cinacalcet vs control, depending on response definition. Mean (SD) per patient total medication costs were $5423 ($3698) for cinacalcet and $2633 ($2334) for control, leading to a mean difference of $2790 over 23 weeks. When response was defined as a decrease in PTH ≥ 30% from baseline, the average cost per responder was $11,266 for control vs $7027 for cinacalcet. The incremental cost per incremental responder ranged from $5186–$9168. Across all response measures, cost per responder was lower in patients with lower baseline PTH.

Conclusions:

Representing a more efficient allocation of economic resources over the short-term, cinacalcet-based treatment algorithm led to a lower cost per biochemical response, particularly in patients with lower disease severity, vs vitamin D sterols and phosphate binders alone. These findings should be interpreted alongside the study limitation of converting international trial-based medication utilization into US costs.

Keywords::

• Cinacalcet
• ESRD
• Secondary HPT
• Response
• Biochemical
• PTH
• Costs
• OPTIMA

Transparency

Declaration of funding

Resources for this study were supported by Amgen Inc.

Declaration of financial/other relationships

VB and ST are employees and stockholders in Amgen Inc. AL and SC were employees and stockholders in Amgen Inc. at the time the study was conducted. JC is a consultant for Amgen Inc. JME Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. Vasily Belozeroff and Andrew Lee participated in the study design, data interpretation, and writing of the manuscript. Spring Tseng was responsible for the statistical analysis, interpretation, and contributed to the writing of the manuscript. Silvia Chiroli contributed to the data interpretation and writing of the manuscript drafts. Jonathan D. Campbell is a consultant for Amgen Inc who participated in the data analysis, data interpretation, and writing of the manuscript. All authors provided their approval of the final manuscript draft.

Acknowledgments

The authors wish to thank Holly Tomlin and Larry Kovalick (employees and stockholders, Amgen Inc.) for medical writing, editing, and journal formatting assistance. During the course of manuscript development, each author had complete access to all the data and contributed to the writing of the manuscript according to the ICMJE criteria as well as Amgen publication policies.