To compare the cost-effectiveness of PTX and cinacalcet for patients with hemodialysis complicated with secondary hyperparathyroidism——a study based on real world data / 中华内分泌外科杂志

ABSTRACT

Objective:To compare the cost-effectiveness of parathyroidectomy (PTX) and cinacalcet in treatment of refractory secondary hyperparathyroidism (SHPT) on hemodialysis.Methods:Hemodialysis patients with refractory SHPT treated in China-Japan Friendship Hospital from Jan. 2016 to Jan. 2019 were retrospective studied. 77 patients treated with PTX and 47 patients treated with cinacalcet were included in the study. The two groups were matched according to the baseline variables, and then a cost-effectiveness analysis from the perspective of the whole society was conducted. The effect index was the total effective rate of treatment for each group for 1 year (the treatment was effective if the parathyroid hormone decreases by≥30% after treatment) , and the cost included the direct cost and indirect cost within 1 year of treatment. Then the incremental cost-effectiveness ratio (ICER) of the two treatment options was calculated, and a single-factor sensitivity analysis on the cost was performed.Results:58 cases in PTX group and 30 cases in cinacalcet drug treatment group were finally matched. The average ages were 47.0±10.1 years and 49.7±12.2 years, respectively. There was no statistical difference between baselines ( P>0.05) . The results of probability density regression (Probit regression) showed that the total effective rate of the PTX group was 27.3% higher than that of the cinacalcet drug group at 1 year of treatment ( P<0.01) . The average total cost of 1 year after PTX was 125,700 yuan, the average cost of cinacalcet drug group was 111,000 yuan, and the ICER of PTX relative to cinacalcet was 53,500 yuan. When each cost changes within the set value range, ICER changes from 30,000 yuan to 62,000 yuan. Conclusion:For patients with hemodialysis complicated with refractory SHPT, if the willing payment for each additional effective treatment case is more than 53500 yuan, the PTX treatment scheme is more economical than the drug treatment of cinacalcet, and the research results are stable.