Assessment of Resource Use and Costs Associated with Parathyroidectomy for Secondary Hyperparathyroidism in End Stage Renal Disease in the UK

Abstract

Introduction:

Secondary hyperparathyroidism (SHPT) is a major complication of end stage renal disease (ESRD). For the National Health Service (NHS) to make appropriate choices between medical and surgical management, it needs to understand the cost implications of each. A recent pilot study suggested that the current NHS healthcare resource group tariff for parathyroidectomy (PTX) (£2071 and £1859 in patients with and without complications, respectively) is not representative of the true costs of surgery in patients with SHPT.

Objective:

This study aims to provide an estimate of healthcare resources used to manage patients and estimate the cost of PTX in a UK tertiary care centre.

Methods:

Resource use was identified by combining data from the Proton renal database and routine hospital data for adults undergoing PTX for SHPT at the University Hospital of Wales, Cardiff, from 2000–2008. Data were supplemented by a questionnaire, completed by clinicians in six centres across the UK. Costs were obtained from NHS reference costs, British National Formulary and published literature. Costs were applied for the pre-surgical, surgical, peri-surgical, and post-surgical periods so as to calculate the total cost associated with PTX.

Results:

One hundred and twenty-four patients (mean age = 51.0 years) were identified in the database and 79 from the questionnaires. The main costs identified in the database were the surgical stay (mean = £4066, SD = £,130), the first month post-discharge (£465, SD = £176), and 3 months prior to surgery (£399, SD = £188); the average total cost was £4932 (SD = £4129). From the questionnaires the total cost was £5459 (SD = £943). It is possible that the study was limited due to missing data within the database, as well as the possibility of recall bias associated with the clinicians completing the questionnaires.

Conclusion:

This analysis suggests that the costs associated with PTX in SHPT exceed the current NHS tariffs for PTX. The cost implications associated with PTX need to be considered in the context of clinical assessment and decision-making, but healthcare policy and planning may warrant review in the light of these results.

Keywords::

• Parathyroidectomy
• Secondary hyperparathyroidism
• ESRD
• Cost
• Cost analysis

Transparency

Declaration of funding

This study was funded by Amgen Ltd., of whom employees helped in the design and undertaking of the study and the writing of the manuscript. All authors were involved in the conduct of the study and the writing and editing of this manuscript. Lucy Hyatt of Amgen (Europe) GmbH provided additional editorial assistance once the draft was complete.

Declaration of financial relationships

EC is an employee of Amgen Ltd., RDP and GC acted as paid consultants, and DSC and KB acted as unpaid consultants to Amgen Ltd. No other conflicts of interest exist.

Acknowledgements

The authors would like to acknowledge the assistance and advice given by Dr James Fotheringham with commentary on the study report.

Previous presentation

These data were presented as ‘Assessment of the Resource Use and Costs Associated with Parathyroidectomy Surgery for Secondary Hyperparathyroidism in End Stage Renal Disease in the UK’ at ISPOR 15th Annual European Congress, 3–7 November 2012, Berlin.