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

Figures & data

Table 1. NHS reference costs 2011–20129.

Admission type	Currency code	Currency description	Activity*	National average unit cost	Number of bed days	Average length of stay (days)
Elective inpatient HRG data	KA03A	Parathyroid procedures with CC	1859	£2648	3229	1.74
Non-elective inpatient HRG data	KA03A	Parathyroid procedures with CC	75	£3431	268	3.57
Elective inpatient excess bed day HRG data	KA03A	Parathyroid procedures with CC	647	£276
Non-elective inpatient excess bed day HRG data	KA03A	Parathyroid procedures with CC	821	£254

*Activity records the number of patients admitted to hospital for that specific currency and admission type.

Table 2. NHS payment by results, National tariff 2011–20128.

Admission type	HRG code	HRG name	Tariff	Trimpoint (days)*
Elective inpatient HRG	KA03A	Parathyroid procedures with CC	£2481	6
Non-elective inpatient HRG	KA03A	Parathyroid procedures with CC	£6202	65
Inpatient excess bed	KA03A	Parathyroid procedures with CC	£200

*The trimpoint relates to the average length of stay to which this tariff applies, hospital stays beyond this trimpoint incur an excess stay payment.

Table 3. Laboratory tests.

Test	Cost per unit	Source
Ultrasound	£145	Cardiff & Vale Hospital Board
Nuclear medicine	£145	Cardiff & Vale Hospital Board
Parathyroid Hormone (PTH)	£21.15	Garside et al.16
Calcium	£2.84	Cardiff & Vale Hospital Board
Computerized Tomography (CT)/ Magnetic Resonance Imaging (MRI)	£144.09	NHS Reference Costs 2010–20119
Electrocardiogram (ECG)	£36.67	NHS Reference Costs 2010–20119
Chest X-Ray	£86.52	Kidney Care17
Full Blood Count (FBC)	£4.57	Kidney Care17
Renal Profile	£4.11	Kidney Care17
Liver Profile	£4.20	Kidney Care17
Glucose level	£1.23	Cardiff & Vale Hospital Board
Lipid levels	£1.99	Cardiff & Vale Hospital Board
Calcium Phosphate	£2.84	Cardiff & Vale Hospital Board

HRG, Healthcare Resource Group; CC, Complications.

Table 4. Patient demographics.

	Database	Questionnaires
Period	2000–2008	2010
Number	124	79
Age	51.1 (13.8)	53.0 (6.0)
Male	46.8%	–
Cause of ESRD
Chronic Renal Failure	38.7%	–
IgA Nephropathy	11.3%
Polycystic Kidney Disease	6.5%
Renal vascular disease  due to hypertension	6.5%
Other causes	37.0%
Length of ESRD Therapy	87.4 months	47.3 months
Dialysis
Haemodialysis	46.0%	62.8%
Peritoneal dialysis	27.6%	17.0%

ESRD, End stage renal disease.

Table 5. Hospital visits, tests, and medications.

	Pre–surgical		Surgical		Peri–surgical
	Database	Questionnaires	Database	Questionnaires	Database	Questionnaires
Hospital visits, n	1*	1.1 (centre mean 1.3)	–	–	1*	7.2 (centre mean 7.7)
GP visits, n	–	–	–	–	–	2.4 (centre mean 12.0)
Test, % patients (n tests)
Ultrasound	–	50.8 (1, 0.4)	–	16.7 (6.0, 0.5)	–	0 (–)
Nuclear medicine	–	35.8 (1, 0.3)	–	0 (–)	–	0 (–)
CT/MRI	–	1.8 (1, 0.02)	–	0 (–)	–	–
PTH	45.2 (1.8)	100 (1.8, 1.7)	19.4 (1.6)	70.8 (1.9, 1.1)	23.4 (1.6)	91.7 (2.0, 1.5)
Calcium	71.0 (4.4)	83.3 (3.1, 2.2)	71.8 (12.2)	66.7 (5.6, 3.8)	60.5 (5.3)	83.3 (8.2, 7.5)
Chest X-ray	–	83.3 (1, 0.9)	–	–	–	–
ECG	–	100 (1, 1)	–	–	–	–
FBC	71.8 (5.8)	100 (3.6, 2.7)	59.7 (4.9)	75.0 (2.9, 1.7)	43.5 (4.7)	100 (3.3, 4.2)
Renal profile	71.8 (5.6)	100 (6.1, 4.3)	67.7 (6.0)	60.0 (3.3, 1.9)	54.8 (3.8)	100 (4.5, 5.2)
Liver profile	71.8 (4.9)	100 (3.3, 2.4)	71.8 (6.4)	70.8 (2.5, 1.4)	61.3 (5.4)	66.7 (2.8, 1.2)
Glucose levels	61.3 (3.4)	85.0 (2.1, 1.5)	33.1 (2.4)	35.0 (3.5, 0.9)	33.9 (3.3)	48.3 (2.3, 0.7)
Lipid levels	32.3 (1.5)	53.3 (1.3, 0.9)	0.8 (1.0)	1.7 (1.0, 0.01)	12.1 (1.1)	11.7 (1.0, 0.1)
Calcium phosphate	71.0 (4.8)	88.3 (2.8, 2.3)	51.6 (4.7)	66.7 (3.9, 1.7)	53.2 (4.6)	66.7 (7.0, 3.0)
Medications, % patients, dose, duration^
Calcium	16.1, 1.3 g, 88.0 days	56.7, 1.4 g, 45.9 days (47.5, 4.8 g, 69 days)	21.8, 2.5 g, 5.6 days	100, 4.8 g, 2.8 days (100, 4.0 g, 3.9 days)	56.5, 2.7 g, 16.6 days	87.5, 4.7 g, 26.2 days (79.7, 4.4 g, 24.6 days)
Vitamin D	35.5, 1 µg, 80.5 days	79.7, 1.6 µg, 9.7 days (77.5, 2.9 µg, 20 days)	42.7, 2 µg, 6.5 days	100, 3.6 µg, 2.8 days (100, 3.7 µg, 3.9 days)	84.7, 3 µg, 19.0 days	92.4, 3.1 µg, 29.7 days (87.5, 3.0 µg, 25.5 days)
Calcium & Vitamin D	–	54.2, 0.8 µg, 40.2 days (38.3, 2.5 µg, 61.7 days)	–	30.4, 1.4 µg, 6.0 days (33.3, 6.0 µg, 6.0 days)	–	30.4, 1.3 µg, 7.7 days (33.3 5.5 µg, 19.5 days)
Phosphate binders	15.3, 2.5 g, 81.6 days	66.3, 2.3 g, 48.8 days (54.2, 6.6 g, 80 days)	15.3, 2.6 g, 5.7 days	67.9, 2.4 g, 2.6 days (64.2, 3.2 g, 4.7 days)	15.3, 2.6 g, 30.1 days	27.7, 0.6 g, 7.2 days (43.4, 3.5 g, 23 days)
Cinacalcet	–	47.3, 0.01 g, 42.6 days (35.0, 0.08 g, 90 days)	–	–	–	–
Antibiotics	–	–	17.7, 1.5 g, 5.6 days	–	23.4, 1.4 g, 19.8 days	–
Analgesics	–	–	47.6, 2.7 g, 5.8 days	–	50.0, 2.7 g, 29.3 days	–

*estimated by physician; ^ centre means provided in parentheses.

GP, General Practitioner; CT/MRI, Computerized Tomography/Magnetic Resonance Imaging; PTH, Parathyroid Hormone; ECG, Electrocardiogram; FBC, Full Blood Count.

Figure 1. Cost of parathyroidectomy (PTX).

Figure 2. Cost of parathyroidectomy (PTX) by phase.

Department of Health. NHS Reference Costs 2011–12. https://www.gov.uk/government/publications/nhs-reference-costs-financial-year-2011-to-2012. Accessed April 2013

 Google Scholar

Department of Health. Payment by Results National Tariffs 2011–2012. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125398.xls. Accessed April 2013

 Google Scholar

Garside R, Pitt M, Anderson R, et al. The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation. Health Technol Assess 2007;11(18):iii, xi-xiii, 1-167

 Web of Science ®Google Scholar

Kidney Care. Developing robust reference costs for kidney transplants Update. 2011. http://www.kidneycare.nhs.uk/Library/DevelopingRobustreferencereportWEBFINAL.pdf. Accessed April 2012

 Google Scholar