Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients.

BACKGROUND: Activated vitamin D is the mainstay of treatment for secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients. However, the optimal route of administration is still debated. The aim of our study was to compare efficacy of oral vs intravenous (IV) administration of alfacalcidol in hemodialysis. A secondary objective was to determine the cost-effectiveness advantage of oral administration. METHODS: Eighty-eight chronic hemodialysis patients receiving IV alfacalcidol three times a week were included in the study. All were switched to the same dose of alfacalcidol given orally three times a week during the hemodialysis session. A budget impact analysis was performed. RESULTS: Mean patient age was 64 years old and 43% were males. The mean alfacalcidol dose administered was 2.1 µg three times a week. After three months, serum parathormone (PTH) levels decreased from 80 to 59 pmol/L (p = 0.001) and total serum calcium levels increased from 2.34 to 2.40 mmol/L (p = 0.002). After six months, total serum calcium levels were still significantly higher. Alfacalcidol dosage was significantly decreased during study period; the mean reduction was 0.44 µg per dose. Finally, oral administration was associated with an annual cost reduction of 197 678$CAN and an annual nursing time reduction of 25 days. CONCLUSION: Our findings support that switching IV to oral administration of alfacalcidol during hemodialysis sessions may lead to a similar control of SHPT with lower doses of activated vitamin D. This is a good strategy for optimizing compliance and may allow a dose reduction because of a greater efficacy to suppress PTH. Oral administration also has significant cost-effectiveness advantages.

Preoperative localization of intracranial lesions with MRI using marking pills.

OBJECTIVE: To describe a simple technique for preoperative surface localization of intracranial lesions. METHODS: 11 pills in total, including Alfarol (alfacalcidol) capsules, were affixed to a phantom with adhesive tape and a MRI scan was performed. The visibility of the pills and any spatial errors in determining their locations were evaluated. Between June 2006 and April 2009, we employed Alfarol capsules as a skin marker in MRI in clinical surgical cases. RESULTS: Alfarol capsules, whose actual size is 5.6 mm in diameter, were identified as a hyperintense spot at a size of 4.2, 4.2, and 4.5mm in diameter in T1-weighted, T2-weighted, and FLAIR (fluid attenuated inversion recovery) sequence images, respectively. The size discrepancies were within 1.4 mm. The average spatial errors were 0.7, 0.6, and 0.7 mm in T1-weighted, T2-weighted, and FLAIR sequence images, respectively. Other pills were not identified in the MRI scans. During this 35-month period, 8 patients underwent preoperative MRI-guided localization at our institution. There were 5 men and 3 women in whom 8 biopsies were performed. In all cases, the result of the biopsy was positive and useful for the treatment that followed. No perioperative complications were encountered. CONCLUSION: Alfarol capsule can be used as an external skin marker. Our simple and inexpensive method is a useful addition to preoperative evaluation of superficial intracranial lesions.

[Economics of medicament therapies for osteoporosis].

For treatment of osteoporosis, medical costs range within 10% among administrations of alfacalcidol, raloxifene and weekly alendronate, because costs of the drugs are shared about 50% of medical costs. Medical costs of the patients suffered from mild lumbago, severe lumbago and femoral neck fracture are compared between the patients with and without the medicament therapies. Preventions of lumbago and fracture by the drugs reduce maximally 16.5% of medical costs. Economics of various therapies to prevent femoral neck fracture in whole Japan show that hip protector gains 73.1 billion yen and medicament therapies lose minimally 826.9 billion yen annually.

The impact of pharmacist intervention on the use of activated vitamin D in a tertiary referral hospital in Malaysia.

OBJECTIVES: In recent years, the usage of activated vitamin D (alpha-calcidol and calcitriol) in the University Malaya Medical Centre (UMMC) has escalated and this has put unnecessary burden on the hospital's limited health care budget. The main aim of this study was to determine the effects of a clinical pharmacist's intervention in reducing the inappropriate use of activated vitamin D. METHODS: Data were collected retrospectively. Pre-intervention data were obtained from records of the previous year's use of activated vitamin D. An intervention screening form was developed based on a new guideline which was produced by the UMMC Osteoporosis Committee. Use of activated vitamin D from August 2006 to July 2007 was reviewed by a clinical pharmacist using the screening form. KEY FINDINGS: Of the 557 requests screened, 44.5% were identified as unnecessary prescriptions. The main indications recommended for prescribing activated vitamin D were long-term glucocorticoid treatment (38.8%) and a bone mineral density T-score of less than -2.5 for patients aged 60 years and above (22.4%). As a result of the intervention, the number of patients on activated vitamin D decreased from 4095 to 2338, which led to a significant reduction in expenditure from RM798 400.60 (US $221,777.90) to RM397 783.80 ($110,495.50) (P = 0.002). The main reasons for the approval of activated vitamin D use were impaired renal function (46.6%) and long-term glucocorticoid use (38.5%). CONCLUSIONS: Pharmacist intervention on the use of activated vitamin D was effective and resulted in a cost saving of up to RM400 616.80 ($111 282.40) annually. Prescribers in the UMMC are now aware of the guidelines and justifications for the use of activated vitamin D. Therefore, the implementation of the guidelines to reduce the inappropriate use of medications is a multidisciplinary effort between pharmacists and prescribers.

Health-economic comparison of paricalcitol, calcitriol and alfacalcidol for the treatment of secondary hyperparathyroidism during haemodialysis.

This study evaluated the health-economic consequences of use of intravenous paricalcitol (Zemplar), oral calcitriol or oral and intravenous alfacalcidol for the treatment of patients with secondary hyperparathyroidism, focusing on a third-party payer perspective through inclusion of medication and hospital costs, survival rates and utilities. Cost values were based on German treatment recommendations and prices. Reference values for survival rates and utilities were based on the results of a MEDLINE search. The analysis showed a clear advantage for intravenous paricalcitol with respect to costs, effectiveness and utilities compared with treatment with oral calcitriol or intravenous alfacalcidol. Since the results were very cost sensitive with respect to selected diagnosis-related groups (DRGs) for kidney disease with dialysis, a sensitivity analysis was performed. This demonstrated first-order dominance of intravenous paricalcitol for a wide range of hospitalisation costs. In conclusion, this analysis suggested a clear benefit from the perspective of a third-party payer for intravenous paricalcitol compared with oral calcitriol and intravenous alfacalcidol in the treatment of patients with secondary hyperparathyroidism.