The cost–effectiveness of drug therapies to treat secondary hyperparathyroidism in renal failure: a focus on evidence regarding paricalcitol and cinacalcet

Abstract

The present review aims to assess the state-of-the-art regarding cost–effectiveness of therapy for secondary hyperparathyroidism in order to identify the best treatment and review methodological issues. PubMed and the Cochrane Library were searched to identify papers performing comparative analysis of costs and effects of treatment for secondary hyperparathyroidism in adult patients. Among the 66 papers identified, only 10 were included in the analysis. Treatment strategies evaluated in the selected papers were: cinacalcet in addition to vitamin D and phosphate binders versus vitamin D and phosphate binders only (seven papers), paricalcitol versus non-selective vitamin D (two papers), early and late introduction of cinacalcet in addition to vitamin D and phosphate binders (one paper) and paricalcitol versus cinacalcet (one paper). The high degree of heterogeneity among alternative treatments and methodological limits related to cost items considered, resource valuation methods and so on, make it unfeasible to reach a definite conclusion regarding cost–effectiveness but allow for future research opportunities.

Keywords:

• calcimimetic
• chronic kidney disease
• cost–effectiveness
• cost-utility
• paricalcitol
• phosphate binders
• secondary hyperparathyroidism

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Chronic kidney disease (CKD) represents one of the major public health concerns given the associated clinical and economic burden as well as the expected prevalence growth due to aging and increased widespread of associated risk factors.

• Secondary hyperparathyroidism (SHPT) is frequenly associated with CKD carrying out a considerable clinical and economic impact.

• Different treatments for SHPT are recommended and some of them poses significant concern because of their costs.

• Cost-effectiveness (CE) evaluation of the different alternatives may guide clinical decisions and the establishment of appropriate guidelines for the management of SHPT.

• Appraisal of the available evidence about the CE of different alternatives may help establishing the available level of evidence and guide future research.

• Available evidence about the CE is currently insufficient to offer clear indication of policy making.

• Most of the CE studies already available are confined to the USA and particularly no CE studies comparing the most promising alternatives are available at the moment.