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

Figures & data

Table 1. Response summary (number and percentage of responders for cinacalcet and control groups).

	Cinacalcet (n = 368)		Control (n = 184)		Incremental percentage (%)
	n	%	n	%
Response (during at least one efficacy time assessment)
PTH ≤ 300 pg/ml	262	71.2	41	22.3	48.9
PTH drop ≥30%	284	77.2	43	23.4	53.8
PTH ≤ 300 pg/ml; Ca < 9.5 and P < 5.5	138	37.5	13	7.1	30.4
	Mean	SD	Mean	SD	Incremental mean
Response (average response time in weeks)
PTH ≤ 300 pg/ml	13.37	7.28	4.06	5.72	9.31
PTH drop ≥30%	14.46	7.12	4.39	5.71	10.07
PTH ≤ 300 pg/ml; Ca < 9.5 and P < 5.5	7.66	6.59	1.17	2.82	6.49

Table 2. Medication wholesale acquisition cost (in US$) and trial-based utilization.

	WAC unit cost*	Cinacalcet arm weekly dose	Use	Control arm weekly dose	Use	Cinacalcet–control dose difference
	$	Mean (SD)	(%)	Mean (SD)	(%)	Incremental mean
Vitamin D Sterols
Oral calcitriol (mcg)	3.530	0.43 (0.87)	30.2	0.65 (1.49)	29.9	−0.22
IV calcitriol (mcg)	5.660	0.36 (1.08)	14.9	0.58 (1.49)	20.7	−0.22
Oral alfacalcidol (mcg)	13.210	0.91 (1.68)	34.8	0.93 (2.10)	27.7	−0.02
IV alfacalcidol (mcg)	3.130	0.22 (1.03)	6.8	0.65 (2.29)	12.0	−0.43
IV paricalcitol (mcg)	3.030	0.05 (0.56)	1.4	0.30 (1.60)	4.3	−0.25
Phosphate binders
Sevelamer (mg)	0.004	15,298.54 (18,268.21)	55.4	20,606.22 (21,906.01)	64.1	−5307.68
Ca-containing binder (mg)	0.001	9479.89 (13,181.49)	73.9	8150.20 (33,619.53)	46.2	1329.69
Cinacalcet
Cinacalcet (mg)	0.450	334.71 (213.76)	98.6	0.07 (0.70)	2.0	334.64

*Analy$ource 2012.

Table 3. Medication trial-based costs ($)*.

	Cinacalcet average patient cost ($)	Control average patient cost ($)	Cinacalcet–control incremental average cost ($)
	Mean (SD)	Mean (SD)	Incremental mean
Vitamin D sterols
Oral calcitriol (mcg)	32.06 (68.09)	52.71 (111.55)	(20.65)
IV calcitriol (mcg)	44.86 (141.34)	66.24 (173.42)	(21.38)
Oral alfacalcidol (mcg)	270.61 (514.77)	283.58 (649.83)	(12.97)
IV alfacalcidol (mcg)	14.22 (70.45)	48.22 (171.91)	(34.00)
IV paricalcitol (mcg)	3.61 (41.24)	21.86 (116.95)	(18.25)
Phosphate binders
Sevelamer (mg)	1437.19 (1822.99)	1959.21 (2140.35)	(522.02)
Calcium containing phosphate binder (mg)	235.18 (334.36)	200.89 (851.42)	34.29
Cinacalcet
Cinacalcet (mg)	3385.17 (2457.77)	0.03 (0.31)	3385.14
Average total medication cost
Average patient total cost ($)	5422.91 (3698.04)	2632.73 (2334.36)	2790.18

*Analy$ource 2012.

Table 4. Average cost ($) per response by definition of response across the 23 week trial period.

	Cinacalcet average cost per response	Control average cost per response	Average incremental cost per incremental response*
Response (during at least one efficacy time assessment)	$/responder	$/responder	$/responder
PTH ≤ 300 pg/ml	7617	11,815	5704
PTH drop ≥30%	7027	11,266	5186
PTH ≤ 300 pg/ml; Ca < 9.5 and P < 5.5	14,461	37,263	9168
Response (Average response time in weeks)	$/response weeks	$/response weeks	$/response weeks
PTH ≤ 300 pg/ml	406	648	300
PTH drop ≥30%	375	600	277
PTH ≤ 300 pg/ml; Ca < 9.5 and P < 5.5	708	2250	430

* (Mean Cost Cinacalcet − Mean Cost Control)/(Mean Response Cinacalcet − Mean Response Control).

Note: Calculated values in this table were generated from non-rounded estimates of cost and percentage response.

Figure 1. Cost per response results by treatment arm and disease severity. *Incremental cost per incremental responder was calculated as the change in the mean per patient costs between cinacalcet and control arms divided by the change in the percentage of patients responding between cinacalcet and control arms. The incremental (cinacalcet – control) cost per incremental responder ranged from $5186–$9168. The incremental increase in mean time spent as a responder ranged from 6.5–10.1 weeks between the cinacalcet and control arms.