COST-EFFECTIVENESS IN KIDNEY MEDICINE: IS CINACALCET SUPERIOR TO PARATHYROIDECTOMY?

K HEGERTY1,2, S JONES1, C SCUDERI1,2, J EGLINGTON1, T BROADBENT1, H ZHANG1, AJ MALLETT1,2
1Kidney Health Service, Royal Brisbane And Women’s Hospital, Herston, Australia, 2Faculty of Medicine, The University of Queensland, Herston, Australia

Aim: To compare parathyroidectomy costs to those of cinacalcet therapy for the treatment of SHPT in CKD patients.
Background: Cinacalcet for treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) has been less available to patients since Australian Pharmaceutical Benefits Scheme funding was withdrawn in August 2016.
Methods: A retrospective audit of CKD patients with SHPT at a tertiary Australian centre who underwent parathyroidectomy from January 2012 to July 2017 (n=34) was undertaken (HREC/17/QRBW/231). ANZDATA reports a median wait time to renal transplant in Australia of 2.4years (range 1.3-4.1years). The centre-specific total cost of 2.4years of cinacalcet therapy 60mg daily was calculated and compared to the total cost of parathyroidectomy based on hospital electronic record data for fractional length of stay (FLOS) and peri-operative complications. A literature review was concurrently undertaken.
Results: The average cost of cinacalcet ($13,149/patient) was found to be more cost-effective than the average total cost of surgery ($23,062/patient) (range $11,375 to $53,279/patient). The median postoperative length of stay was 7.51days (range 3.47-35.74days).
The literature reviewed appeared divided on the issue of cost-effectiveness. Belozeroff et al. assessed 181 patients 6 months post parathyroidectomy and found that the combined cost of treatment for hypocalcaemia, re-admission rates and an increase in physician encounters led to a lower overall cost with cinacalcet therapy.  In contrast, Narayan et al. found that parathyroidectomy was more cost effective by 7.6 months post-operatively.
Conclusion: This emphasizes the importance of assessing the cost-effectiveness of therapies in clinical medicine, especially nephrology. In this cohort at a single Australian tertiary centre we identified cinacalcet to be more cost-effective than parathyroidectomy as a treatment approach in CKD patients with SHPT.


Biography:
Advanced Trainee in Nephrology at the Royal Brisbane and Women’s Hospital

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